颅脑创伤术中出现急性脑膨出的原因分析及救治措施

Analysis of the causes of acute brain bulge during craniocerebral trauma surgery and the treatment measures

目的分析颅脑创伤术中发生急性脑膨出的原因和有效救治措施。方法回顾性分析苏州大学附属第一医院2012年6月—2017年12月收治颅脑创伤患者术中发生急性脑膨出26例,其中男性15例,女性11例;年龄19～75岁,平均38. 1岁。伤后至急诊手术时间为1～6h。平均1. 5h。顶枕部16例,额颞部10例。手术方式采用标准大骨瓣开颅,术中采取控制性降颅压策略,逐步释放颅内压。结果术后存活20例,死亡6例。术后GOS评定:恢复良好7例,中残2例,重残6例,植物生存5例。结论颅脑创伤术中发生急性脑膨出由多种因素引起,迟发性颅内血肿和急性弥漫性脑肿胀是主要原因,及时复查头部CT明确急性脑膨出的原因,针对病因采取有效措施是降低致死、致残率的关键。

Objective To study the causes and effective treatment of acute brain bulge in patients with craniocerebral trauma. Methods The clinical data of 26 patients with craniocerebral trauma who received craniotomy with acute brain bulge from Jun. 2012 to Dec. 2017 were retrospectively reviewed and analyzed,including 15 cases of males and 11 cases of females aged from 19 to 75 years（38.1 years on average）. The average time from injury to emergency surgery was 1-6h （1.5h on average）. Sixteen cases were in the occipital region and ten cases were in the frontotemporal region. Standard large bone flapr craniotomy was used,intracranial pressure was released step by step with controlled strategy. Results After operation,20 patients survived and 6 died. According to GOS,7 patients had good recovery, 2 patients with moderate disability,6 patients with severe disability and 5 patients with vegetable survival. Conclusion The acute brain bulge occurred in craniocerebral trauma is caused by many factors. Delayed intracranial hematoma and acute diffuse brain swelling are the main reasons. Timely review of head CT to clear the cause of acute brain bulge,and effective measures for the etiology are keys to reduce death and disability rate.