急性外伤性颅内血肿合并脑疝的救治体会

Treatment experience of the acute traumatic intracraniai hematoma combined with Herniation.

目的探讨急性外伤性颅内血肿合并脑疝的救治要点以及影响预后的因素，以提高急性外伤性颅内血肿合并脑疝的诊断和治疗水平，降低其病死率。方法1997年2月至2008年6月我院共收治急性外伤性颅内血肿合并脑疝患者45例，均及时建立有效的通气和循环并进行术前检查，单纯开颅血肿清除术8例，清除血肿加去大骨辩减压术33例，未手术治疗4例。结果治愈好转26例（58％，26／45），死亡19例（42％，19／45）。结论及时建立有效的通气和循环是防治急性外伤性颅内血肿合并脑疝患者继发性脑损伤的有效方法；尽快清除血肿，解除对脑干的压迫是抢救成功的关键。预后与原发性脑损伤程度、术前意识水平和脑疝出现的时间有密切关系。

Objective To investigate the key procedures of the acute traumatic intracranial hematoma combined with herniation and the prognosis factors. Methods 45 cases of acute traumatic intracranial hematoma combined with herniation from February 1997 to June 2008 were admitted in our hospital. Timely establishment of effective ventilation and circulation and pre-operative examination were done to all the cases. Craniotomy hematoma clean was performed in 8 cases, hematoma ctean and decompressive craniectomy was conducted in 33 cases and 4 cases were not operatively treated. Results 26 cases （58%） were cured,and 19 cases （42%） died. Conclusions The key procedures of the acute traumatic intracranial hematoma combined with herniation is timely establishment of ef- fective ventilation and circulation, and that is effective method to prevent secondary brain injury; removing hematoma as soon as possible, and lifting the oppression of the brain stem are the keys to rescue patients. Prognosis is closely related to the degree of primary brain injury, conscious level before operation and the time of herniation appearance.