32例以颅脑损伤为主的多发伤救治体会

Management of traumatic brain injury in the poly-trauma patients

目的探讨死亡率高、治疗棘手的以颅脑损伤为主的多发伤的救治策略。方法回顾分析了我中心2007年收治的32例以颅脑损伤为主的多发伤患者病历资料及其救治方法,并总结其救治经验。结果32例合并颅脑损伤的多发伤患者,损伤严重度评分（ISS）10-34分（平均17.42分）;格拉斯哥昏迷评分（GCS）〈5分4例,5-8分10例,9-12分18例;所有伤者在早期行简单固定、止血、包扎后进行全身CT扫描,24例伤者接受了紧急开颅探查、血肿清除手术（其中去骨瓣减压术单侧8例,双侧12例）,同时进行骨折外支架固定术10例,胸腔闭式引流术8例,剖腹探查、脾切除术1例,伤口清创术20例。术后ICU监护治疗,Ⅱ期确定性手术治疗。痊愈18例,占56.25%;轻残6例,占18.75%;重残2例,占6.25%;植物生存2例,占6.25%;死亡4例,占12.50%。结论在维持全身生命体征稳定的同时,优先处理颅脑损伤,及早手术控制颅内高压,防止由于低氧、低血压和高热引起的继发性颅脑损伤,是合并颅脑损伤的多发伤的救治策略。

Objective To study the management of traumatic brain injury in the poly-trauma patients who have high mortality and low cure rate.Methods Data on 32 poly-trauma patients with traumatic brain injury in our hospital during 2007 were reviewed.Results The ISS score was 10-34,averaging 17.42.There were 4 cases with GCS5,10 cases with GCS 5-8,and 18 cases with GCS 9-12.All of them were taken whole body CT scanning after fixation,bleeding stopping and bandaging.Twenty-four patients received emergency craniotomy（decompressive craniotomy,8 for one side,12 for both sides）.At the same time,10 received external fixation for fracture,8 closed drainage of thoracic cavity,1 exploratory laparotomy and splenectomy,20 debridement.Then patients were monitored and managed in ICU till the period II operation.At last,18 were cured（56.25%）,6 little disability（18.75%）,2 serious disablity（6.25%）,2 vegetable surviving（6.25%）,4 deaths（12.50%）.Conclusion After maintaining the nomal life sign,treating the traumatic brain injury preferentially,taking operation to control acute intracranial hypertension,preventing the secondary injury from hypoxia,hypotension,and hyperpyrexia as soon as possible are the right ways to treat the traumatic brain injury in the poly-trauma patients.