大骨瓣开颅联合亚低温治疗外伤后急性弥漫性脑肿胀

Decompressive Craniectomy and Mild Hypothermia on Patients with Post-traumatic Acute Diffuse Brain Swelling

目的探讨外伤后急性弥漫性脑肿胀治疗效果及影响疗效的主要因素。方法对31例外伤后急性脑肿胀患者的治疗资料进行回顾性分析。所有患者均接受去骨瓣减压手术和术后亚低温治疗。结果术后6个月按GOS评分标准评估:良好9例(占29.0%)、中残6例(占19.4%)、重残6例(占19.4%)、植物生存4例(占12.9%)、死亡6例(占19.4%)。结论早期去骨瓣减压和术后立即亚低温联合治疗,可以改善患者预后,而术前急性全脑肿胀和术中出现急性脑膨出,患者预后较差。

Objective To investigate effects and factors associated with clinical outcomes of decompressive craniectomy and mild hypothermia on patients with post-traumatic acute diffuse brain swelling（PADBS）.Methods The clinical data of 31 patients with PADBS,who underwent a combination with decompressive craniectomy and mild hypothermia were analyzed retrospectively.all data available on patients’age,Glasgow Coma Scale（GCS）,pupil size and reaction,CT scans and intracranial pressure were collected and analyzed.Results The patients’ outcome was evaluated by the Glasgow Outcome Scale（GOS） on follow-up of 6 months,9 patients（29.0%）recovered well,6（19.4%） moderately disabled,6（19.4%） severely disabled,4（12.9%） vegetatively survived and 6（19.4%） died.Conclusion Combination with the early decompressive craniectomy and mild hypothermia is an effective way to improve patients outcome.Acute generalized brain swelling before operation and acute brain fungus in craniotomy are strongly associated with poor outcome.