重型颅脑损伤患者开颅术中急性脑膨出的原因及防治措施研究

Study on the causes and prevention measures of acute brain swelling in patients with craniotomy for severe craniocerebral injury

目的分析重型颅脑损伤患者开颅术中急性脑膨出的原因及防治措施。方法选取本院2014年5月至2015年5月收治的40例重型颅脑损伤患者开颅术中急性脑膨出患者,对其临床资料进行总结与回顾,对其临床表现进行观察与分析,并对其发病原因以及防治措施进行研究以及分析。结果经过研究发现,21例(52.50%)患者为迟发性的颅内出血,其中5例(12.50%)为同侧脑内血肿,3例(7.50%)为同侧硬膜外血肿,6例(15.00%)为同侧硬膜下血肿,3例(7.50%)为对侧硬膜外血肿,4例(10.00%)为对侧脑内血肿。12例(30.00%)为急性弥漫性脑肿胀;7例(17.50%)患者为外伤性(大面积)脑梗死。40例患者中,治愈8例(20.00%),中度残疾8例(20.00%),重度残疾10例(25.00%),植物生存8例(20.00%),死亡6例(15.00%)。结论开颅手术后出现脑膨出的原因多种多样,因此医护在术中应提高警惕,并对其危重患者的临床表现特别注意,对其脑膨出的发病原因进行确定,在确定病情后,再为其制定相应的处理措施,提高救治成功率,减轻对脑部组织造成损伤。

Objective： To analyze the causes and prevention measures of acute brain swelling in patients with eraniotomy for severe craniocerebral injury. Methods ： Forty cases of acute brain swelling in patients with eraniotomy for severe cranioce- rebral injury who accepted treatments in our hospital from May, 2014 to May, 2015, and the clinical data were summarized and reviewed, the clinical manifestations were observed and analyzed, and the causes and prevention measures were re- searched and analyzed. Results： After the research,it was found that among the 21 eases （52. 50% ） of patients with de- layed intracranial hemorrhage, eases （12. 50% ） had ipsilateral intracerebral hematoma, 3 cases （7.50%） hard adventi- tial hematoma, 6 eases （ 15.00% ） patients side hard adventitial hematoma, 3 cases （7.50%） hard adventitial hematoma, and 4 cases （ 10. 00% ） intracerebral hematoma. 12 cases （30. 00% ） of patients had acute diffuse brain swelling; 7 eases （17.50%） of the patients had cerebral infarction （raumatie large area）. In 40 cases of cerebral infarction 8 eases （20. 00% ） were cured, 8 cases （20. 00% ） had moderate disability, 10 cases had severe disability （25.00%）. 8 eases were the survival of vegetative patients （20. 00% ） , death in 6 cases （ 15.00% ）. Conclusion： The causes of encephalocele after craniotomy are various. Therefore, care should be taken, and special attention should be paid to the clinical manifesta- tions of the critically ill patients to determine the causes of encephalocele. After the conditions are determined, correspond- ing measures should be formulated to improve the treatment success rate, and reduce the cause of brain tissue damage.