62例重型颅脑外伤伴休克的救治

Salvage and treatment of sixty-two severe brain injury complicated with shock

目的探讨重型颅脑外伤伴休克的救治方案。方法回顾2002-01～2006-12间收治的62例重型颅脑伤伴休克病例。全部患者入院时均有不同程度休克表现。GCS≤8分,ISS评分平均32.6分。抢救按照损伤控制外科的原则而进行,以抢救生命为主,抓好呼吸、循环及脑受压三个重要环节,颅内血肿、脑疝伴其他部位损伤并休克者两个部位同时手术。全部病例均收住EICU,重点进行生命体征监护,各个脏器功能保护,控制感染,注重早期肠道营养,防治MODS出现。结果治愈22例(35.5%),轻残6例(9.7%),重残15例(24.2%),植物生存5例(8.1%),死亡14例(22.6%)。死亡原因:脑疝晚期中枢神经功能衰竭2例,不伴脑疝的严重创伤性休克5例,术后患者因多器官功能衰竭7例。结论重型颅脑伤并休克救治重点是颅内血肿、脑疝、休克和呼吸功能障碍,治疗中统筹兼顾,遵循损伤控制外科的原则,必要时两个部位同时手术以挽救患者的生命。强调了新急诊模式及EICU在抢救中的重要地位。

Objective To discuss the salvage and treatment plan of severe brain injury complicated with shock. Methods Sixty - two severe brain injury complicated with shock from 2002.1 to 2006.12 in our hospital were retrospectively analyzed. All the patients had shock at different degrees. GCS grade ≤ 8, average ISS was 32.6. Salvage was performed according to principle of Damage Control Surgery. To save life firstly, then to pay more attention to respiration, circulation, brain. Patients had encephalic haematoma accompanied with other injuries and shock were operated at the same time. All the cases were hospitalized in EICU, and emphasis was put on intensive care of life sign, protection of organ function, controlling infection, early intestinal nutrition, prevention and treatment of MODS. Results 22 cases （35. 5%） was cured, 6 cases （9.7% ） was lowgrade disability, 15cases （24.2% ） severe disability,5 cases （8.1%） vegetative state, 14 cases （22.6%） died. Death reasons： central nerve function failure 2 cases, severe traumatic shock not complicated with cerebral hernia 5 cases, muhiple organ function failure after the operation 7 cases. Conclusion Emphasis of salvage and treatment of severe brain injury and shock is encephalic haematoma, cerebral hernia, shock and respiratory function failure. In the treatment, plan is key as a whole, principles of Damage Control Surgery should be observed, two parts were operated to save patients/lives at the same time. New emergency mode and EICU are important in salvage and treatinement.