重型颅脑外伤伴休克的救治

Treatment of severe brain complicated with shock

目的探讨重型颅脑外伤伴休克的救治方案。方法回顾分析121例重型颅脑外伤伴休克病例的临床资料,患者入院时GCS≤8分,ISS评分平均32.6分。抢救按照损伤控制外科的原则进行,以抢救生命为主,抓住呼吸、循环及脑受压三个重要重要环节,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。全部病例术后均入住EICU,重点进行生命体征监护,保护脏器功能,控制感染,重视早期肠道营养,防治MODS发生。结果治愈48例(39.67%),轻残11例(9.09%),重残30例(24.79%),植物生存7例(5.79%),死亡25例(20.66%)。死亡原因:脑疝晚期中枢神经功能衰竭3例,不伴脑疝的严重创伤性休克11例,术后因多脏器功能衰竭11例。结论重型颅脑外伤并休克救治重点是颅内血肿、脑疝、休克和呼吸功能障碍,在治疗中应统筹兼顾,遵循损伤控制外科的原则,必要时进行两个部位同时手术以挽救患者生命,强调了新急诊模式及EICU在抢救中的重要地位。

Objective To discuss treatment of severe brain injury complicated with shock. Methods One hundred and twenty-one patients with severe brain injury complicated with shock were retrospectively analyzed. Results 48 cases （39.67%） was cured. 11 cases （9.09%） was low-grade disability, 30 cases （24. 79%） severe disability, 7 cases （5.79%） vegetative state, 25 cases （20. 66%） died. Conclusion Emphasis of salvage and treatment of severe brain injury and shock is encephalic haematoma, cerebral hernia, shock and respiratory function failure.