外伤性颅内血肿致脑疝的外科综合治疗

Surgical combined therapy to treat cerebral hernia leaded by traumatic intracranial hematoma

目的：回顾性研究外伤性颅内血肿致脑疝患者的救治经验，探讨手术为主的外科综合治疗措施，以改善患者的预后。方法：分析108例外伤性颅内血肿致脑疝患者的颅内血肿类型、临床特征、抢救措施、手术方式及预后状况。结果：全组67例GCS3分。5分，41例GCS6分。8分。GOS预后：恢复良好28例（25．93％），中残10例（9．26％），重残18例（16．67％），植物生存6例（5．56％），死亡38例（35．19％）。结论：早期诊断和及时手术减压、标准外伤大骨瓣减压术、亚低温治疗、高压氧治疗、颅内压监护、血浆渗透压监测、加强术后的监护和防治并发症，是提高外伤性颅内血肿致脑疝患者救治成功率和改善其生存质量的重要手段．

Objective： A retrospective clinical study for the cerebral hernia leaded by traumatic intracranial hematoma has been made to explore effective treatments in order to improve outcomes. Methods： From 1999 to 2004, 108 cases of tentorial herniation following traumatic intracranial hematomas were retrospectively studied about the types of intracranial hematomas, the clinical characteristic, the modalities of treatment and operation and prognosis. Results： 67 cases had GCS score 3-5 and 41 cases GCS score 6-8. 28 cases （25.93%） survived well , 10 cases suffered from （11.11%） moderate disability, 18 case （16.67%） severe deficit, 6 cases （5.56%）vegetative and 38 cases （35.18%） death according to GOS. Conclusions： Early diagnosis and operative decompression promptly, standard large trauma craniectomy, moderate hypothermia, hyperbaric oxygen, observations of intracranial pressure and osmotic pressure of plasma, competent special care and decreasing the complications after operation are important measures to achieve good recovery and improve the survival quality for the patient with tentorial herniation following intracranial hematomas.