颅脑损伤合并肝损伤的救治

Treatment of 46 cases of head injury and liver injury

目的 总结颅脑损伤合并肝损伤救治的经验和教训 ,探讨影响患者死亡的因素。方法 1993～ 1999年收治的46例颅脑损伤合并肝损伤的患者根据其临床表现分成 3组 :Ⅰ组 17例为颅脑损伤严重而肝损伤较轻者 ;Ⅱ组 18例为肝损伤严重而颅脑损伤较轻者 ;Ⅲ组 11例为颅脑损伤和肝损伤均严重者。颅脑损伤严重、肝损伤严重者分别行手术治疗 ,损伤较轻者按非手术治疗。结果 Ⅰ组开颅手术 17例 ,肝损伤按非手术治疗 ,其中 3例转手术治疗 ,病死率为 2 3 5 % ;Ⅱ组行肝损伤的手术治疗 18例 ,颅脑损伤按非手术治疗 ,其中 4例转手术治疗 ,病死率为 33 4% ;Ⅲ组全部手术治疗 ,病死率为 72 7%。显著高于Ⅰ组和Ⅱ组 (χ2 分别为 6 6 0 ,5 5 7,P均 <0 0 5 )。全组病死率为 37 0 %。结论 及早明确诊断 ;术前积极救治 ;早期开颅手术解除颅内高压 ,控制肝脏破裂大出血 ;掌握非手术治疗的适应证 。

Objective To summarize the experiences and lesson in treatment of 46 cases of head injury and liver injury and determine the risk factors for death.Methods From 1993 to 1999,46 patients with head injury and liver injury were treated in our hospital.They were divided into 3 groups according to their clinical status:the 17 cases were severe head injury and mild liver injury patients in Ⅰ group.The 18 cases were severe liver injury and mild head injury patients in Ⅱ group. The 11 cases were severe head injury and severe liver injury patients in Ⅲ guoup.The surgical treatment was for performed of severe head injury and severe liver injury.The no-surgical treatment for patients of mild head injury and mild liver.Results Craniotomy of 17 cases and surgical treatment 3 cases of liver injury transformed from no-surgical treatment in Ⅰ group.Case-fatality rate was of 23.5%.Surgical treatment 18 cases of liver injury and craniotomy 4 cases transformed from no-surgical treatment in Ⅱ group.Cases-fatality rate was 33.4%.The whole patients were surgical treatment in Ⅲ group.Case-fatality rate was 72.7%.The death rate of Ⅲ group is significantly higher than Ⅰ group and Ⅱ group.All groups cases-fatality rate was 37.0%.Conclusions It is recommended that early definite diagnose,active to treatment before operation,early craniotomy for reducing the intracranial hypertension and control massive haemorrhage of hepatorrhexis,mastering indication of no-surgical treatment, to attach importance to post operative treatment can reduce the case-fatality rate. [