脑外伤后进展性出血性脑损伤的诊治体会

Experience and treatment of progressive hemorrhagic injury after traumatic brain injury

目的研究脑外伤后进展性出血性脑损伤的临床特点,总结其发病机制,探讨及时诊断、治疗的方法。方法回顾性分析解放军第二五一医院神经外科自2015年1月至2017年6月收治的167例脑外伤后进展性出血性脑损伤患者的临床资料。本组患者入院时按GCS评分:3~5分11例,6~8分36例,9~12分83例,13~15分37例。临床表现均有不同程度的颅高压症状,观察治疗过程中,76例患者出现意识障碍或意识障碍加深,94例患者肢体肌力减退,81例患者频繁呕吐,43例患者躁动,5例患者脑疝。结果手术治疗94例,保守治疗73例。所有患者依据GOS评分判断:恢复良好114例,中残32例,重残13例,死亡8例(4.8%)。结论动态CT观察是早期发现进展性出血性脑损伤的有效方法。对外伤性颅内血肿的患者绝不能仅仅依赖首次CT结果即制定一成不变的治疗方案,应进行专科监测和动态CT观察,根据患者血肿量的变化及时调整治疗方案。

Objective To investigate the clinical feature of progressive hemorrhagic injury（PHI） after traumatic brain injury and to summarize the pathogens of PHI and to investigate the method of timely diagnosis, timely treatment for PHI. Methods One hundred and sixty seven cases of PHI after traumatic brain injury which admitted in our hospital from Jan 2015 to Jun 2017 were analysed retrospectively. According to GCS scores of 167 cases of PHI after traumatic brain injury on admission：3-5 points in 11 cases, 6-8 points in 36 cases,9-12 points in 83 cases,13-15 points in 37 cases. All patients expressed the symptom of increased intracranial pressure in different degrees. During observation and treatment, 76 cases expressed disorder of consciousness or consciousness obstacle deepened, 94 cases expressed limb strength weakening, 81 cases vomited frequently, 43 cases with restlessness, 5 cases with brain hernia. Results The 94 patients were performed operation and the108 patients were performed conservative care. According GOS score to judge： surgical outcome were good in 114 cases, light disability in 32 cases, severe disability in 13 cases and dead in 8 cases. The total mortality rate is 4.8%. Conclusion The early diagnosis of PHI after traumatic brain injury depends on the doctor＇s vigilance. The follow-up of CT scan of head was effective method to find the PHI. It is mistaken to draw up an invariable cure plan only according to the first CT scan of head for the patients who suffer from traumatic intracranial hematoma. It is right to regulate the cure plan according to the changes of the patient＇s hematomas and observe the changes of patients and to supervise the CT scan of head.