迟发性颅内血肿患者再次开颅手术后病情特点及治疗对策

Characteristics and treatment countermeasures in patients with delayed intracranial hematoma after second craniotomy operation

目的探讨迟发性颅内血肿患者再次开颅手术后病情特点及治疗对策。方法选择2010年1月至2011年5月该院收治的行一次开颅手术262例为对照组,因迟发性颅内血肿再次手术42例为观察组,比较两组患者的临床资料。结果与对照组比较,观察组出现呼吸、循环障碍及多器官功能障碍综合征(MOSD)增多,部分凝血指标出现异常,两组患者术后均出现不同程度的低血红蛋白、低蛋白血症、低钾血症及酸中毒,但两组比较差异无统计学意义(P>0.05),观察组出现继发感染更多,感染更重。结论迟发性颅内血肿患者再次开颅术后病情加重,针对其病情特点需要在术中纠正低血红蛋白、低蛋白血症及凝血功能异常,术后加强支持及抗感染治疗。

Objective To explore the characteristics of the patients with delayed intracranial hematoma after craniotomy operation again and to discuss its treatment countermeasures.Methods 262 patients with once craniotomy operation in this hospital from January 2010 to May 2011 were selected as the control group and contemporaneous 42 patients with second craniotomy operation due to delayed intracranial hematoma as the observation group.The clinical data were compared between the two groups.Results Compared with the control group,respiratory and circulation barriers and MODS in the observation group were increased significantly,coagulation function abnormality,low hemoglobin,hypoalbuminemia,hypokalcemia,acidosis and secondary infection rate were higher and infection was severer in the observation group.Conclusion The patients with delayed intracranial hematoma will get worse after second craniotomy operation.Aiming at the condition characteristics,it is needed to correct low hemoglobin,hypoalbuminemia and coagulation dysfunction during operation,at the same time,enhance the supportive treatment and anti-infection treatment after operation.