重型颅脑外伤致脑疝患者的临床救治体会

Clinical Treatment Experience of the Severe Craniocerebral Injury Associated with Cerebral Hernia

目的:探讨重型颅脑外伤致脑疝的临床救治方法并总结救治体会,以提高重型颅脑外伤致脑疝患者的临床救治水平,提高其生存率。方法:回顾性分析2006年1月～2011年12月年收治的220例重型颅脑外伤致脑疝的患者的临床资料,探讨综合性救治措施对重型颅脑外伤致脑疝患者的临床意义。结果:根据格拉斯哥预后评分(GOS)评价全组预后:45例恢复良好(20.5%),34例中残(15.5%),41例重残(18.6%),25例植物生存(11.4%),75例死亡(34.1%),其中7例术中死亡,28例术后死于感染、消化道出血及多器官功能衰竭等严重并发症,40例死于脑损伤及继发脑功能严重衰竭。结论:颅脑外伤致脑疝患者致死率高,预后差,采取术前、术中、术后的综合救治措施,可显著提高患者生存率及改善预后。

Objective： To investigate the clinical treatment method of the severe craniocerebral injury with cerebral hernia in order to improve the clinical therapeutic effect and increase the survival rate.Methods： 220 patients with cerebral hernia caused by severe craniocerebral trauma,admitted from January 2006 to December 2011 were retrospectively studied to analyze the important significance of comprehensive treatment on the severe craniocerebral injury associated with cerebral hernia.Results： Treatment outcomes were assessed according to GOS,there were 45 cases（20.5 %） of good recovery,34 cases（15.5 %） of moderate disability,41 cases（18.6 %） of severe disability,25 cases（11.4 %） of plant survival,75 patients（34.1 %） died.The intraoperative death happened in 7 cases,28 cases died of postoperative infection,gastrointestinal hemorrhage and multiple organ failure and other serious complications,40 cases died of brain in-jury and secondary brain function in severe failure.Conclusions： The patients with cerebral hernia caused by craniocerebral trauma,often have the high fatality rate,and the poor prognosis.Taking the preoperative,intraoperative,postoperative comprehensive treatment mea-sures,can significantly improve the survival rate and improve the prognosis of the patients.