重型颅脑损伤术中急性脑膨出29例救治分析

Clinical analysis of severe craniocerebral injury with intraoperative acute encephalocele in 18 cases

目的总结重型颅脑损伤开颅术中急性脑膨出的救治经验。方法回顾性分析29例重型颅脑损伤患者开颅术中出现脑膨出的临床资料。结果本组死亡14例(48.3%),植物生存3例(10.3%),重残2例(6.9%),轻残4例(13.8%),恢复良好6例(20.7%),术中迟发性颅内血肿形成、外伤后急性弥漫性脑肿胀是术中并发急性脑膨出的主要原因。结论明确病因及时手术可改善预后,术中采取过度通气,控制性低血压降低颅内压,彻底清除颅内血肿,充分减压,改善脑组织缺血缺氧是治疗急性脑膨出的有效措施。

Objective to summarize the experiences in treating severe craniocerebral injury with Intraoperative acute en cephalocele. Methods The clinical data of 29 patients with severe craniocerehral injury complicated with intraoperative acute en- cephalocele was retrospectively analyzed. Results 14 cases died （48.3 %）, 3 cases （10.3 %） in plant survival,2 case （6.9 % in severe disabilities）, 4 cases （1 3.8 % ） in light damage, 6 patients （20.7 % ） in good recovery, intraoperative late intracranial he- matoma,acute diffuse brain swelling after trauma were the main causes for intraoperative acute encephalocele. Conclusion Timely clearing etiology for surgery may improve the prognosis, taking hyperventilation, controlled hypotension to reduce in- tracranial pressure, completely clearing intracranial hematoma, full dec0mpression,improving cerebral ischemia and hypoxia dur- ing surgery are effective measures for the treatment of acute encephalocele.