醉酒对外伤性颅内进展性出血手术治疗影响分析

Effects of acute alcoholism on operation for patients with progressive hemorrhagic injury after traumatic brain injury

目的提高醉酒后外伤致颅内进展性出血(PHI)患者的手术疗效,以改善患者预后。方法回顾性总结263例头部外伤后颅内进展性出血手术治疗患者的临床资料,比较分析醉酒对手术时机、术中出血量、2次手术发生率以及手术预后的影响。结果与同期192例非酒后外伤颅内进展性出血手术治疗患者比较,71例醉酒患者中,伤后6 h内行开颅手术治疗占32.4%、术中出血量>800 ml占33.8%、2次手术发生率32.4%、预后良好率(优良+轻残)仅70.4%,差异均有统计学意义(P<0.05)。结论重视醉酒后外伤致颅内进展性出血的早期发现和及时手术治疗,注意术中术后处理,减少2次手术发生率,以提高手术疗效。

【Objective】 To improve the operative effects and the prognosis of patients of acute alcoholism complicated with progressive hemorrhagic injury（PHI） after traumatic brain injury（TBI）. 【Methods】 The clinical data of 263 patients who received operation for PHI after TBI were summarized. The patients were divided into two groups according to alcohol drinking or not. An analysis was retrospectively performed about the effects of acute alcoholism on the operation opportunity, amount of bleeding during operation, the rate of second-operation and the prognosis of the patients. 【Results】 Compared with the 192 patients who did not drink before injury, 32.4% of the 71 patients who were drunk received operation within the first 6 hours after injury, 33.8% had intraoperative blood loss of more than 800 ml, 32.4% had second-operation and only70.4% had favorable prognosis including fine recovery and mild disability with significant differences（P〈0.05）. 【Conclusions】 To improve the operative effects on patients of acute alcoholism complicated with PHI after TBI, it is necessary to have early and correct diagnosis and timely operation. Adequate intraoperative and postoperative measures should be taken in order to reduce the occurrence of second-operation.