术中处理创伤性大脑浅静脉损伤对颅脑损伤患者预后的影响

Intraoperative processing traumatic brain injury superficial vein of the influence of the prognosis of patients with craniocerebral injury

目的探讨创伤性大脑浅静脉损伤机制与创伤性脑梗死的关系对预后的影响及对创伤性大脑浅静脉的有效处理措施。方法 2006年6月～2010年10月笔者所在科室收治颅脑损伤患者2660例,其中36例合并有术中证实的大脑浅静脉损伤。分析本组患者的临床及影像学资料。结果伴有大脑浅静脉损伤的36例中合并颅骨骨折24例,36例均合并有急性硬膜下或脑内血肿,并发有不同程度的创伤性脑梗死。伤后6个月,36例患者中10例预后较佳,26例预后不佳。结论颅骨骨折直接损伤是导致大脑浅静脉损伤的主要原因,大脑浅静脉损伤是导致创伤性脑梗死的重要原因,合并有大脑浅静脉损伤的颅腩损伤患者伤患差,死残率高。术中注意保护受损大脑浅静脉和给予受损静脉周围充分减压,以及术后防止受伤静脉栓塞和血管痉挛是提高此类患者预后的有效措施。

Objective To investigate the mechanisms of superficial cerebral veins injury and explore its relationship with traumatic cerebral infarction and the prognosis. Methods 36 patients with traumatic superficial cerebral veins injury were admitted to our hospital from June 2006 to February 2009. The clinical and radiographic data was analyzed. Results 24 eases of skull fracture and 36 cases of subdural or/and cerebral hematoma were found. All of the 36 cases had traumatic cerebral infarction. 10 patients had good outcomes, and 26 had poor outcomes. Conclusion Skull fracture is the main cause of superficial cerebral veins injury ,and superficial cerebral veins injury is one of the key factors which causes traumatic cerebral infarction. Patients with superficial cerebral veins injury were subject to poor prognosis and have relatively high morbidity and mortality. Decompression and protection of the injured superficial cerebral veins during the operation and the prevention of venous embolism and angiospasm after the operation can improve the prognosis.