颅脑外伤去大骨瓣减压术后并发脑膨出67例临床分析

Clinical analysis of 67 patients with traumatic brain injury by decompressive craniectomy complicated with external cerebral herniation

目的探讨颅脑外伤去骨瓣减压术后并发脑膨出的临床特点及其与损伤程度、预后的关系。方法选取89例颅脑外伤去大骨瓣减压术后患者,对其进行回顾性分析,测量患者术后不同时间段(术后3、7、14、30、60d)的脑膨出程度,对患者随访6个月,并分析脑膨出与患者术前GCS评分,伤后6个月GOS评分的关系。结果 89例脑外伤去大骨瓣减压术后患者,死亡9例,长期昏迷、植物状态14例,重度残疾30例,中度残疾14例,恢复良好22例,术后发生脑膨胀患者67例,发生率为75.3%;比较术后不同时间的脑膨出程度发现:14d时脑膨出程度达到高峰,且与3、7、30、60d脑膨出程度之间比较差异有统计学意义(P<0.05),其余各时间段差异无统计学意义(P>0.05)。GCS评分低组更易出现脑膨出(P<0.05)。术后6个月不同GOS组之间脑膨出发生率的差异无统计学意义(P>0.05)。结论颅脑外伤去大骨瓣减压术后患者脑膨出发生率较高,脑膨出程度14d达到高峰之后逐渐减轻。GCS评分低的患者更容易出现脑膨出。

Objective To explove the correlation with the clinic characteristics the degree of damageand progosis of patients with traumatic brain injury（TBI） by decompressive craniectomy（DC） complicated with external cerebral herniation.Methods 89 patients with TBI by DC were retrospectively analyzed.The thickness of external cerebral herniation were measured at different post-operative point time（after third day,first week,second week,first month and second month）.In addition,the initial GCS and 6 month GOS after operation were recorded and correlated with external cerebral herniation.Results According to the GCS,the general information of 89 patients was as follows：9 patients died;14 patients of long-term coma or plant survival;30 patients of sever disability;14 patients of moderate disability;22 patients of good recovery.There were 67 patients complicated with external cerebral herniation.The incidence of external cerebral herniation was 75.3%.Compared with the extent of external cerebral herniation at different post-operative point time,the pinking point was the 14th day after operation.There was no difference between another post-operative time point.The incidence of external cerebral herniation was not significantly different between 6 month GOS.Conclusion There is higher incidence of external cerebral herniation in patients with TBI by DC.The extent of external cerebral herniation is pinking in the 14th days and decrease gradually after opreration.There is a positive correlation between initial GCS and incidence of external cerebral herniation.The lower initial GCS,the higher incidence of external cerebral herniation.