以中-重型颅脑损伤为主的多发伤患者综合救治分析

Analysis on comprehensive treatment of patients with moderate-severe traumatic brain injury combined with multiple trauma

目的探讨以中-重型颅脑损伤为主的多发伤患者的救治策略。方法回顾分析44例以中-重型颅脑损伤为主的多发伤患者病历资料及其救治方法,并总结救治经验。结果颅脑损伤中急性硬膜下血肿最多,有21例(47.73%),急性硬膜外血肿9例(20.45%),脑挫裂伤7例(15.91%);合并伤数量最多的为骨科损伤,共25例(56.82%),其中为四肢骨折最多,共18例(40.91%);术后三个月根据格拉斯哥预后评分(glasgow outcome scale,GOS),恢复良好23例(52.3%),轻度残疾6例(13.6%),重度残疾3例(6.8%),植物生存7例(15.9%),死亡5例(11.4%)。结论优先处理中-重型颅脑损伤,及早手术控制颅内高压,其他部位损伤采取损伤控制手术,积极防治低氧、低血压和创伤致死三联征是治疗合并中-重型颅脑损伤为主的多发伤患者的救治策略。

Objective To investigate the therapeutic strategies for patients with moderate-severe traumatic brain injury combined with multiple trauma. Methods The clinical data and therapeutic method of 44 patients with moderate-severe traumatic brain injury combined with multiple trauma were analyzed retrospectively. Treatment experience of moderate-severe traumatic brain injury with multiple trauma were summarized. Results The most common type of traumatic brain injury is acute subdural hematoma,found in 21 cases（ 47. 73%）,acute epidural hematoma in 9 cases（ 20. 45%）,cerebral contusion in 7 cases（ 15. 91%）. Orthopedics injury,as the most frequent associated injury,was found in 25 cases（ 56. 82%）. The most common type of orthopedics injury is limbs fracture,18 cases（ 40. 91%）. According to glasgow outcome scale（ GOS）,23 cases revealed（ 52. 3%） after three months of postoperation follow up,patients got good recovery,6 cases（ 13. 6%） had moderate deficits,3 cases（ 6. 8%） severe deficits,7 cases（ 15. 9%） were in vegetative status and 5（ 11. 4%） were dead. Conclusions Treating traumatic brain injury preferentially,performing surgeries to control acute intracranial hypertension,taking damage control operation in multiple trauma,preventing and treating hypoxia,hypotension,and trauma triad of death as soon as possible are the therapeutic strategies for patients with moderate-severe traumatic brain injury combined with multiple trauma.