重度颅脑损伤术中急性脑膨出35例

Thirty-five cases of acute encephalocele during server traumatic cerebral operation

目的探讨重度颅脑损伤术中急性脑膨出的成因及治疗对策。方法对35例重度颅脑损伤术中急性脑膨出病人的临床资料、治疗及结果进行回顾性分析。结果35例重度颅脑损伤术中急性脑膨出病人中,术中直接探查6例发现4例颅内血肿其中同侧脑内血肿2例、术区周边硬膜外血肿1例、对侧硬膜外血肿1例;术中及手术结束时CT复查显示弥漫性急性脑肿胀15例;迟发性颅内血肿或原血肿增大12例,其中远隔部位硬膜外血肿7例、对侧硬膜下血肿2例、对侧脑内血肿2例、同侧脑内血肿1例。因麻醉不良气道压力高致脑膨出1例。术前已诊断急性脑肿胀者3例。急性脑肿胀15例中5例接受双侧去骨瓣减压,2例生存。3例术前诊断急性脑肿胀患者接受双侧去骨瓣减压,2例生存。术中CT复查发现迟发性颅内血肿或原血肿增大12例患者中7例接受二次手术,5例存活。术中直接探查行血肿清除4例术后2例死亡。35例患者中共死亡21例,其中急性脑肿胀中14例、颅内血肿者7例。结论重度颅脑损伤术中急性脑膨出原因多为急性脑肿胀和术区周边及远隔部位迟发性颅内血肿形成或血肿增大,不同的成因应采取相应的对策,才能进一步提高疗效。

Objective To discover the reasons and treatment methods for acute encephalocele during server traumatic cerebral operation. Methods Retrospective analysis of 35 patients with acute encephalocele was made. inter - operation CT images were especially studied in time. Results With in 35 cases of acute encephat cocele 6 cases were directly explored ： there were 4 cases of intracerebral hematomas found： two homonymy intracerebral hematomas, one peri - operation region extradural hematomas, one opposite side extradural hematoma were found; there were 16 cases of sudder intracranial hematomas showing on the CT scan during and/or at the end of the operation, twelve delayed intracranial hematomas, 7 of twelve were extradural hematomas, 2 were subdural hematomas, 3 intracerebral hematomas. While nineteen cases of acute diffuse brain swelling were diagnosed. Eight of nineteen eases of acute diffuse brain swelling received bilateral eraniectomy, four eases survived. With in 35 cases, 21 were dead, 14 died were acute diffuse brain swelling, 7eases died of intracerebral hematomas. Conclusion The main cause of acute eneephalocele were delayed intracranial hematomas and acute diffuse brain swelling. Elect proper treatment according to identifying different reasons of acute eneephaloeele can improve the healing effect