重型颅脑损伤二次手术原因及效果分析

Clinical study of reoperation after craniotomy in the patients with severe craniocerebral injury

目的探讨重型颅脑损伤后二次手术的原因、处理方法及效果。方法回顾分析我院2003-12～2009-12收治的29例重型颅脑损伤行二次手术患者的临床资料。结果根据格拉斯哥预后分级(GlasgowOutcome Scale,GOS)评分法,本组29例患者出院时GOS 1分(死亡)9例,GOS 2分(植物生存)4例,GOS 3分(重残)5例,GOS 4分(中残)7例,GOS 5分(良好)4例。结论二次手术患者多数有多发性损伤、病情危重、致残率及病死率高的原因,掌握手术时机和正确的手术方式,术后严密监测及积极处理复合伤等,可改善患者预后。

Objective To study the cause,treatment and effect of reoperation after craniotomy in the patients with severe eraniocerebral injury. Methods The clinical data of the reoperation after craniotomy in 29 patients with severe craniocerebral injury were retrospectively analyzed. Results According to GOS, good outcomes were achieved （ GOS Ⅴ） in 4 patients, moderate disability （ GOS Ⅳ） in 7 patients, severe disability （ GOS Ⅲ ） in 5 patients, vegetative status （ GOS Ⅱ ） in 4 patients, death （ GOS Ⅰ ） in 9 patients. Conclusion Most of the patients with severe craniocerebral injury undergoing reoperation have multiple combined injuries, high disability rate and death rate. The timely and correct operation, strict monfioring and proper treatment of combined injuries could improved the patients＇ prognosis.