重型脑外伤行开颅手术中发生急性脑膨出的诊断与治疗

Diagnosis and Treatment of Acute Brain Encephalocele in Craniotomy for Severe Brain Injury

目的分析重型脑外伤患者行开颅手术中发生急性脑膨出的诊断与临床治疗效果。方法抽取30例本院自2016年9月—2017年12月收治的重型脑外伤行开颅手术中发生急性脑膨出患者,分析术中发生急性脑膨出原因,同时实施针对性治疗措施,分析诊断与临床治疗效果。结果 30例术中发生急性脑膨出患者在初诊时与诊疗时,有以下特点:用手触摸膨出脑组织较软或较硬,且术中出现低血压;经CT检查硬膜下出现血肿;广泛脑组织水肿。通过实施去骨瓣、颞肌甚至颞叶脑组织减压治疗,死亡率为43.3%。结论重型脑外伤患者在行开颅手术时,易出现急性脑膨出症状,给予相应的预防及治疗措施,提高预后效果。

Objective To analyze the diagnosis and clinical efect of acute encephalocele in patients with severe brain injury during craniotomy. Methods 30 patients with acute encephalocele during craniotomy for severe brain injury admitted to our hospital from September 2016 to December 2017 were selected. The causes of intraoperative acute encephalocele were analyzed, and targeted treatment measures were implemented to analyze the diagnosis and clinical treatment effect. Results In 30 patients with acute brain swelling during the initial diagnosis and treatment, there were following characteristics the brain tissue is soft or hard after touching the bulging brain tissue, and hypotension occurs during operation; CT Examination of hematoma under the subdural; extensive brain tissue edema. By performing decompression of the deboned flap, diaphragm, or even temporal lobe, the mortality rate was 43.3%. Conclusion Severe craniocerebral trauma patients are prone to acute encephalocele when craniotomy is performed, and appropriate preventive and therapeutic measures should be given to improve the prognosis.