31例重型颅脑损伤术中急性脑膨出临床分析

Clinical Analysis of 31 Patients with Acute Encephalocele in Operation of Severe Craniocerebral Injury

目的：探讨重型颅脑损伤患者术中急性脑膨出的临床特点。方法：回顾性分析31例重型颅脑损伤术中脑膨出患者的临床资料，总结分析脑膨出原因及其治疗结局。结果：本组31例患者经治疗，恢复良好4例（12.9%），中残6例（19.4%），重残5例（16.1%），死亡16例（51.6%），患者死亡率随GCS评分降低而增高，其中GCS评分为3-5分者死亡率显著高于6-8分及9-10分患者（P〈0.05）；31例患者脑膨出原因分别为弥漫性脑肿胀14例（45.2%），迟发性颅内血肿8例（25.8%），广泛性脑挫裂伤合并颅内多发血肿或严重脑水肿9例（29.0%）。结论：重型颅脑损伤术中急性脑膨出患者的治疗较为复杂，治疗结局与术前GCS评分、脑膨出原因具有密切关系，但术前给予全面评估，术中积极配合其他治疗措施均对改善预后具有重要意义。

Objective：To discuss the clinical features of patients with acute encephalocele in operation of severe craniocerebral injury. Methods：The clinical data of 31 patients with acute encephalocele in operation of severe craniocerebral injury were retrospectively analyzed, and the causes of encephalocele and treatment outcome was summarized. Results：After the treatment, 4 patients（12.9%） had good recovery, 6 patients（19.4%） were moderate disability, 5 patients（16.1%） were severe disability, and 16 patients（51.6%） died;patients’ mortality were increased with the reducing of GCS, and patients with GCS 3-5 had significantly higher mortality than with GCS6-8 and GCS9-10（P〈0.05）; causes of acute encephalocele were diffuse brain swelling, 14 cases（45.2%）, delayed intracranial hematoma, 8 cases（25.8%）, and cerebral contusion merge multiple intracranial hematoma, 9 cases（29.0%）. Conclusion：The treatment of patients with acute encephalocele in operation of severe craniocerebral injury is complex, treatment outcomes were related with GCS before the operation and causes of acute encephalocele, comprehensive assessment of preoperative, other actively cooperate treatment measures intraoperative have important significance in improving the prognosis.