重型颅脑损伤术中急性脑膨出的原因及防治

The reason and treatment of acute encepha locele during operation in severe head injury

目的:探讨重型颅脑损伤术中急性脑膨出的原因与防治措施。方法:回顾分析36例术中急性脑膨出病例的临床资料,总结其临床特征和救治经验。结果:急性弥漫性脑肿胀、迟发性颅内血肿、低血压、低血氧症,是重型颅脑损伤术中脑组织膨出主要原因。结论:术前脱水降颅压,采用大骨瓣开颅,术中控制收缩压、过度换气;切开硬脑膜时缓慢放出颅内血肿,对着力部位有骨折的对冲伤者,术中一旦出现脑膨出难以控制,应首先行对侧开颅;动脉收缩压<90mmHg,要及时纠正,以维持有效的脑灌注压。

Objective:To discuss the reason and treatment of acute brain bulgement in severe cerebral trauma.Methods:Retrospectively analyse data of 36 cases acute brain bulgement,and summarize it′s clinical character and treatment experience.Results:Acute diffuse brain swelling,delayed intracranial hematoma,low blood pressure,hypo-oxyemia are main reason for the brain bulgement in severe brain injury.Conclusion:All the following method can be effective,which include de-hydration before surgery,large skull flap,systemic pressure control,hyper-ventilation,slowly removal intracranial hematoma during dura-octomy,when the patients have contra-coup injury with skull fracture on the other side,the cranioctomy on the same side should executed immediately on the situation that brain bulgement are out of control,systolic pressure should be corrected to maintian the effective brain perfusion if it is lower than 90 mmHg.