高海拔地区重型颅脑损伤的急诊手术治疗

Emergency micro-neurosurgery treatment of severe brain injury in high-altitude area

目的探讨高海拔地区重型颅脑损伤的急诊手术救治方法及疗效。方法本组40例重型颅脑损伤患者GCS评分小于8分,均行开颅手术清除血肿、挫灭脑组织清除、内减压、去骨瓣减压及相关专科治疗。结果恢复良好20例(50.0%);轻度残疾9例(22.5%);重度残疾6例(15.0%);植物生存2例(5.0%);死亡3例(7.5%)。结论对于重型颅脑损伤病人的救治,应争分夺秒,有手术指征的急诊手术尽可能地减少副损伤。术后观察、药物治疗及合并伤的治疗可以有助于降低二次脑损害的发生。早期进行高压氧治疗,有助于改善患者脑缺氧及脑水肿,促进患者康复。

Objective To discuss the surgerical treatment for severe brain injury in high-altitude area. Methods Totally 40 cases,The GCS scale of which were all below 8, and all were treated by operation, including evacuation of intracranial hematoma decompressive, dehydration therapy to depress intracranial pressure, craniectomy and correlative department treatment. Results About 20 cases （50.0%） had a good recovery, 9 cases（22.5% ） had a slight disability, 2 cases （5.0%） had a persistent vegetative state, and the other 3 dead after therapy. Conclusion The key for patients with severe brain injury was to provide immediate treatment, and decrease the operation by-injury, the second brain injury could be reduced by giving observation, drug treatment and complication treatment after operation. Early hyperbaric oxygen therapy was help to improve lack-oxygen of brain, hydrocephalus and accelerate the healing of patients.