48例额叶对冲伤的临床救治

Treatment of 48 cases with frontal contrecoup injury

目的额叶对冲伤多见于枕部受力的颅脑损伤,早期意识障碍轻,但病情复杂,恶化多变,常因来不及抢救而导致严重的后果。方法男性38例,女性10例,年龄8～73岁,车祸伤33例,坠落伤和意外跌伤11例,枕部打击伤4例。GCS<5分8例,GCS 6～8分15例,G C S 9～12分9例,GCS 13～15分16例。一侧散大13例,双侧散大6例。CT扫描枕骨骨折26例,单侧额叶脑挫裂伤32例,双侧额叶脑挫裂伤16例,伴颞叶挫裂伤者17例,单侧额叶脑内或硬膜下血肿19例,双侧额叶脑内或硬膜下血肿8例。手术治疗28例,保守治疗20例。方法恢复良好和中残37例,重残6例,死亡5例。结论①伤后和第一次C T扫描有枕骨骨折及对冲部位的脑挫裂伤及血肿宜采取较积极的治疗方案,手术指征应适当放宽。②采取保守治疗应密切观察生命体征及神志瞳孔变化,动态C T观察。③手术尽可能清除脑内血肿与挫伤失活的脑组织,同时行必要的颅内外减压,包括额极切除及去骨瓣外减压。④注意纠正电解质紊乱,早期适当给予改善微循环药物。

[Objective] Frontal contrecoup injury were seen mostly in occipital brain injury. Conscious disturbance was not severe in early stage but deteriorate quickly. [ Methods] 38 cases are male. 10cases are female. Age between 8-73 years. 33 cases were injured by ear accident, 11 by fallen injury and accident, and 4 by occipital injury. 8 cases＇ GCS〈5. 15cases＇GCS 6-8. 9 cases＇ GCS 9-12. 16 cases＇ GCS 13-15, 13 cases with unilateral mydriasis. 6 cases with bilateral mydriasis.26eases with oeeiput fracture by CT. 32 cases with unilateral frontal contusion, 16 cases with bilateral frontal contusion, 17 cases with temporal contusion, and 19 with unilateralsubdural hematoma. 8 cases with bilateral hematoma. 28cases were treated by surgery. 20cases were taken eonservative treatment. [ Results ] 37 eases recovered well or suffered from moderate disability. 4 eases remained severe disability. 5 eases died. [ Conclusion ] ①eases with occipital fracture, contreeoup contusion and hematoma after injury and first CT should be treated more positively. ②cases with conservative treatment should monitor the physical signs, consciousness and pupils. CT should be taken depending on the condition. ③eases with hematoma and inactiwation brain tissue should be eliminated and taken necessary decompression including trauma eraniotomy and frontal eranieetomy. ④water-electrolyte disorder should be rectified in time. Medicine that can improve mieroeireulation should be used in early stage.