重型颅脑损伤患者术中急性脑膨出临床分析

Clinical Analysis of Intraoperative Acute Encephalocele in Patients with Severe Craniocerebral Injury

目的分析重型颅脑损伤患者术中急性脑膨出的原因和救治方法。方法对2003年12月-2008年8月13例术中出现急性脑膨出的重型颅脑损伤患者进行回顾性分析。结果术侧脑内血肿3例,对侧骨折局部硬膜外血肿5例,脑内血肿1例,术侧骨窗周围硬膜外血肿1例,弥漫性脑肿胀1例,另2例未行CT复查原因不清。死亡4例,伤后半年GOS评估,植物生存1例,重残2例,中残1例,良好5例。结论术中出现脑膨出时,首先考虑术侧脑内血肿、对侧骨折局部硬膜外血肿,再考虑对侧脑内血肿、术侧骨窗周围硬膜外血肿、弥漫性脑肿胀等。按顺序探查,必要时复查CT明确诊断给予及时、有效处理是救治术中急性脑膨出的重点。

Objective To analyze the reason and remedy of intraoperative acute encephalocele in severe craniocerebral injury patients.Methods Total patients with intraoperative acute encephalocele in severe craniocerebral injury admitted to our department from December 2003 to August 2008 were analyzed retrospectively.Results The intraoperative acute encephalocele occurred in 13 patients with severe craniocerebral injury,among whom,3 suffered from homolateral intracranial hematomas,5 suffered from contralateral epidural hematoma in she area of skull fracture, 1 suffered from contralateral intracranial hematomas, 1 suffered from homolateral epidural hematoma around operating field, 1 suffered from acute diffuse cerebral swelling, and 2 patients were unknown without CT scan. In the 13 cases with intraoperative acute encephalocele,5 patients had a good outcome, 1 moderately disabled,2 severely disabled, 1 survived as persistent vegetative state, and 4 died. Conclusion Intraoperative acute encephalocele is mainly caused by homolateral intraeranial hematomas or eontralatera epidural hematoma in the area of skull fracture,and secondly caused by contralateral intraeranial hematomas,homolateral epidural hematoma around operating field or diffuse cerebral swelling.