创伤性脑肿胀患者术中术后脑膨出的防治探讨

Investigation the prevention and treatment methods of encephalocele during intraoperative and postoperative in the patients with traumatic brain swelling

目的探讨创伤性脑肿胀患者术中术后脑膨出的防治措施。方法将采用大骨瓣减压术治疗的76例创伤性脑肿胀病例分为两组,两组病例术中采用不同方法治疗,观察分析两组病例术中术后发生脑膨出机率。结果第一组40例患者术中脑膨出36例,占90.0%,第二组36例患者术中脑膨出11例,占30.6%。76例患者术后不同阶段不同程度膨出66例,占86.8%。结论创伤性脑肿胀患者,采用"尽早减压、逐步减压"、顺序硬脑膜切开法、维持正常脑灌注压和切开硬膜后1小时内开始快速关颅能明显降低术中术后脑膨出发生率,降低致残和死亡率。

Objective To investigation the measures to prevent and treat encephalocele during intraoperative and postoperative in the patients with traumatic brain swelling.Methods 76 cases of traumatic brain swelling traumatic by using the big bone flap decompression in the treatment of traumatic brain swelling were included and divided into 2 groups,the probability for encephalocelet during intraoperative and postoperative were observed in these 2 grops.There were 36 cases of encephalocelet out of 40 in the first group（90%）,and there were 11 cases of encephalocelet out of 40 in the second group（30.6%）.And there were stage postoperation（86.8%）.Conclusion Traumatic brain swelling in patients,using ＂decompression as early as possible and decompression step by step＂,order of dural incision method,sustainment for normal cerebral perfusion pressure and dissection putamen within 1 hours after the beginning of fast closing skull can significantly reduce the incidence of postoperative cerebral encephalocele during operation,reduce the rate of disabled and death.