颅脑损伤双瞳孔散大病人的急救

EMERGENCY RESCUE OF PATIENTS WITH CRANIAL INJURY AND BOTH PUPIL DILATATION

目的：讨论颅脑损伤双瞳孔散大病人的急救措施，降低病死率。方法：分析了104例双瞳孔散大病人在抢救室行气管插管、颈内动脉注射甘露醇、颅骨钻孔减压、再根据瞳孔回缩情况决定是否手术及术式的抢救经验。结果：按GOS判断，恢复良好31．7％，中残4．8％，重残3．8％，植物生存3．8％，病死55．7％。结论：紧急气管插管、颈内动脉注射甘露醇、颅骨钻孔减压是有效的急救措施；若瞳孔回缩后开颅手术疗效好，若不回缩开颅手术无价值。

Aim: We discussed the emergency rescue of patients with cranial injury and both pupil dilatation to decrease the mortality. Methods: One hundred and four cases of cranial injury with both pupil dilatation after treated with tracheal intubation, injection of mannitol through internal carotid artery, releasing intra-cranial pressure by cranial drilling, then,according to the contraction response of pupils, we decide the necessity of surgical operation. Results: According to the GOS, 31. 7% was recovered, 4. 8% was moderate handicapped; 3. 8% was severe handicapped,3. 8% was vegetative, and the mortality rate was 55. 7%. Conclusion: Treatment by tracheal intubation, injection of mannital in internal carotid artery and skull drill decompression is effective for the emergency rescue of patients with cranial injury and both pupil dilatation. The prognosis is better if both pupils contracted before the open-cranial operation than those without contraction response