重型颅脑损伤术中急性脑膨出的原因分析及治疗经验交流

Causes analysis and treatment strategy of acute encephalocele in the postoperation of severe craniocerebral injury

目的探讨重型颅脑损伤术中急性脑膨出的原因及治疗经验。方法回顾性分析2012年3月至2016年10月在我院颅脑外科治疗的48例重型颅脑损伤术中急性脑膨出患者的临床资料,分析导致急性脑膨出的原因,观察并分析治疗方法及效果。结果在48例患者中,发生进展性出血性损伤24例(50.00%)、急性弥慢性脑肿胀19例(39.58%)、长时间脑疝4例(8.33%)、术中低氧血症1例(2.08%);24例给予单侧开颅,24例给予双侧开颅;随访12个月,死亡19例,存活29例;依据GOS评分,恢复良好13例(44.83%)、中度残疾9例(31.03%)、重度残疾5例(17.24%)、植物状态2例(6.90%)。结论重型颅脑损伤术中急性脑膨出的产生原因较多,临床发生率较高,临床主要依据影像学检查结合临床表现判断发病原因,并采取针对性治疗措施,可改善患者预后。

Objective To analyze the causes and treatment strategies of acute encephalocele in the postoperation of severe craniocerebral injury. Methods The clinical data of 48 cases of patients with acute cerebral and operation of severe craniocerebral injury with craniocerebral surgery in our hospital from March 2012 to October 2016 were retrospectively analyzed. The causes of acute encephalocele were analyzed and the treatment methods and effects were observed and analyzed. Results In 48 cases of patients, there were 24 cases of progressive hemorrhagic injury （50.00%）, 19 cases of acute diffuse brain swelling （39.58%）, 4 cases of long time cerebral hernia （8.33%）, 1 cases of hypoxemia （2.08%）. Twenty- four cases were treated with unilateral craniotomy, 24 cases were treated with bilateral craniotomy. After 12 months of follow-up, 19 cases died and 29 cases survived. According to the GOS score, 13 cases （44.83%） recovered well, 9 cases were moderate disability （31.03%）, 5 cases were severe disability （17.24%）, and 2 cases were vegetative state （6.90%）. Conclusion There are many causes of acute encephalocele in severe craniocerebral injury, which has high clinical incidence. The clinical findings of which are mainly based on imaging findings and clinical manifestations, and targeted treatment measures can improve the prognosis of the patients.