颅脑损伤术中急性脑膨出救治分析

Acute encephalocele in the operation of craniocerebral injury

目的探讨颅脑损伤开颅术中急性脑膨出的原因及防治措施。方法回顾分析86例在开颅手术中出现急性脑膨出的重型颅脑损伤患者的临床资料。结果迟发性颅内血肿42例,急性脑肿胀38例,大面积脑梗塞及其他原因6例。伤后半年按GOS评估,恢复良好27例,中残15例,重残9例,植物生存7例,死亡28例。结论术前应综合分析判断发生术中脑膨出的可能性,对迟发性颅内血肿早期诊断,及早清除血肿减压;对急性脑肿胀或大面积脑梗塞引起的脑膨出及早去除病因,迅速减压关颅。

Objective To discuss the main causes, prevention and cure of acute encephalocele in the opera- tion of craniocerebral injury. Methods A retrospective analysis was performed to the clinical data of the 86 cases with acute encephalocele in the operation of severe cranioccrebral injury. Results Out of the 86 cases, 42 cases led by delayed intracranial hematoma, 38 cases caused by acute brain swelling, and 6 cases produced by large cerebral infarc- tion and other causes. After half a year, according to GOS outcome score, good recoveries in 27 cases, moderate deficits in 15 cases, severe deficits in 9 cases, vegetative status in 7 cases, and death occurred in 28 cases. Conclusion It can remarkably improve the therapeutic effect and prognosis with the preoperative analysis of encephalocele possibility, the earlier diagnosis for encephalocele caused by delayed intracranial hematoma, clear encephalocele to degrade the in- tracranial pressure. For the encephalocele caused by acute brain swelling or large cerebral infarction should remove the reason,degrade the intracranial pressure and close cranium earlier.