颅脑损伤术中继发颅内出血原因分析

Cause analysis of intracranial hemorrhage during operation on patients with brain injury

目的探讨颅脑损伤手术中继发颅内出血的可能原因及其处理策略。方法回顾性分析22例因颅脑损伤行开颅手术治疗且术中继发颅内出血患者的临床资料，对不同类型颅内出血进行归类。结果22例患者中继发硬膜外血肿12例，以并发手术对侧血肿多见；脑内血肿者5例，以手术同侧脑内血肿多见；急性硬膜下血肿者4例，均发生于首次手术对侧；皮瓣下血肿1例。结论颅脑损伤开颅手术中所继发的颅内出血以硬膜外出血最多见，其次为脑内、硬膜下出血及手术皮瓣下出血，术前明确患者受力机制及仔细辨别可能存在的骨折线，术中采用梯度减压、彻底清除破碎脑组织、保护回流静脉、严谨止血是预防继发性脑出血的重要措施。

Objective To study the possible reasons and the processing strategy of brain injury operation complicated with intracranial hemorrhage. Methods The clinical data about 22 patients who were digged skull operation because of brain injury and complicated with intracranial hemorrhage in operation in neurosurgery from 2007 June to 2008 February were retrospectively analyzed, and different types intracranial hemorrhage were classified. Results In 22 patients, 12 patients were complicated with epidural hematoma,in which the patients （9/12,75.0%） complicated with opposite hematoma were common;5 patients were complicated with intracerebral hematoma,in which the patients （3/5,60%） complicated with ipsilateral hematoma were common;4 patients were complicated with acute subdural hematoma, and all the patients complicated with opposite hematoma; 1 patient was complicated with sub-flap hematoma. Conclusions In the patients who are complicated with intracranial hemorrhage because of digging skull operation to brain injury,epidural hematoma are most, then intracerebral hematoma, subdural hematoma, sub-flap hematoma. The important measures of preventing secondary intracranial hemorrhage are definiting force mechanism and distinguishing fracture line before operation, gradiently decompressing,completely removing crushing brain tissue, protecting reflux veins,rigorously stopping bleeding during operation.