重型颅脑损伤术中急性脑膨出的临床分析

The analysis of acute intraoperati.ve encephalocele insevere head-injured patients

目的探讨重型颅脑损伤手术中急性脑膨出的原因及有效的防治措施。方法对31例重型颅脑损伤患者手术中出现急性脑膨出进行回顾性分析，总结其形成原因，比较各种防治措施的疗效。结果急性弥漫性脑肿胀、迟发性颅内血肿、严重脑挫裂伤、脑疝时间长、脑组织缺血和缺氧等是造成重型颅脑损伤手术中急性脑膨出的主要原因。结论针对不同病因采取相应措施如彻底清除颅内血肿、适当控制血压、使用脱水剂和激素、过度通气、缓慢降低颅内压等是防治术中出现急性脑膨出的有效措施，提高临床疗效。

Objective To summarize the causes and prophylactic theyapeutic methods of acute intraoperative eneephalocele in severe head-injured patient. Methods Thirty-one severe head injured patients with acute intraoperative eneephalocele were analysed retrospectively and the preventive and treating methods were implemented. Results Acute diffuse brain swelling, delayed intracranial heamatomas, larcerationwere, long-term brain herniation and cerebral anoxia were the main causes of intraoperative eneephalocele. Conclusion According todifferent causes, the methods of treatment should be removes heamatomas completely, decreasing intracranial pressure gradually, intraoperative hyperventilation, large dose of mannitol and maintain of systolic blood pressure respectively, the acute intraoperative encephaloeele in head injured patients could be prevented and treated effectively.