78例老年人重型颅脑损伤临床分析

Retrospective analysis of severe head injuries in elderly men

７８ 例老年人重型颅脑损伤（ ＨＳＩ） ，其ＧＣＳ 评分均在３ ～８ 分，存活５５ 例（７０ ．５１ ％ ） ，死亡２３ 例，病死率为２９ ．４９ ％ 。认为采用颅内压（ＩＣＰ） 监护，ＧＣＳ 评分和观察瞳孔改变相结合的方法对判断预后具有重要意义。其病死率的高低及预后与原发或继发性脑损害的程度有关，而ＩＣＰ 的高低是判断原发或继发性脑损害程度的可靠指标。脑缺血、受压、微循环障碍是引起脑继发性损害、造成死亡的主要原因。治疗脑损害适情尽早手术，积极防治脑缺血，有效地改善脑微循环，早期应用脑保护剂，注意酸碱及水电解质平衡，保护和调节各脏器的正常机能等，是提高老年人ＨＳＩ 的生存率。

The severe head injury in 78 elderly men were treated in our hospital. Their GCS was between 3 to 8. 55 of them survived, the survival rate was 70.51%. 23 died, the fatality rate was 29.49%. It indicated that the combined methods of ICP monitor, GCS evaluation, and observation on changes of pupils were valuable for prediction of the prognosis. The fatality rate and prognosis were correlated with the degree of primary or secondary severe head injury. ICP levels were reliable index for the judgement of degrees of primary or secondary severe head injury. Cerebral ischema, encephalothlipsis and microcirculation dysfunction were the major factors of the death induced by secondary brain injuries. The major steps to improve the survival rate of elderly severe head injury and decrease the fatality rate were earlier surgery, prevention of cerebral ischema, improvement of brain microcirculation, giving brain protective agent in early stage, paying attention to acid-base, water-electrolyte balance and protection of the normal function of each organs.