迟发性硬脑膜外血肿所致的术中急性脑膨出

Intraoperative Acute Brain Bulge Induced by Delayed Epidural Hematoma in Patients with Head Injuries

目的 分析急性颅脑损伤后开颅血肿清除术中急性脑膨出的原因。方法 对发生于近5年内开颅血肿清除术中发生的急性脑膨出患者进行统计,总结其中迟发性硬脑膜外血肿发生情况。结果 5年中发生于颅脑损伤后开颅血肿清除术中的急性脑膨出患者75例,其中迟发性外伤性硬脑膜外血肿25例(25/75),占同期外伤性硬脑膜外血肿的5.1％。死亡6例,死亡率为24％(6/25)。结论 颅脑损伤后减压术中出现原因不明的颅内压增高、脑膨出时,应首先排除迟发性硬脑膜外血肿的可能,以防漏诊,延误治疗。

Objective To analyze the cause of acute brain bulge during the craniotomy in the patients with head injuries. Method Data of the patients with brain injuries in whom acute brain bulge occurred during cramiotomy in recent 5 years (1996-2000) were analyzed retrospectively. Results There were 75 patients with brain injuries in whom acute brain bulge occurred during the craniotomy and among them, 25 cases of delayed epidural hematomas (DEDH) were amounted to 5.1% of the total number of traumatic epidural hematoma happened in the same period. Six cases of 25 cases with DEDH died. Conclusion When unexpected intracranial hypertension and acute brain bulge were encountered during craniotomy in the management of the patients with head injuries, the possibility of DHDH should be suspected and appropriate therapeutic measures then be instituted.