双侧标准大骨瓣减压联合亚低温治疗重型颅脑损伤伴脑疝形成(附28例报告)

Bilateral Standard Decompressive Craniectomy with Large Bone Flap Resection Combine with Mild Hypothermia for Severe Traumatic Brain Injury Patients with Brain Herniation(28 Cases Report)

目的分析探讨双侧标准大骨瓣减压联合亚低温治疗重型颅脑损伤的临床效果。方法总结28例重型颅脑损伤患者,均经临床GCS评分及影像学诊断确诊,术前双侧瞳孔散大19例;术前一侧瞳孔散大9例,此9例均术中发生脑膨出,颅内压增高,行CT复查对侧血肿4例,弥漫性脑肿胀5例。所有患者均在伤后2 h内行急诊双侧标准大骨瓣减压,术中术后联合亚低温治疗,并采取脑外伤后常规对症支持治疗。结果 28例患者经治疗,根据格拉斯哥预后评分(GOS评分)取得如下治疗效果:康复良好6例,中残3例,重残4例,植物状态11例,死亡4例,死亡率14.3%。结论重型颅脑损伤伴脑疝形成的患者病情凶险,死亡率高,及早标准大骨瓣减压术联合围手术期亚低温可显著降低颅内压,降低死亡率。

Objective To analysis and evaluate the clinical effects of bilateral standard decompressive craniectomy with large bone flap resection combine with mild hypothermia for severe traumatic brain injury patients with brain herniation,and to summarize processing experience. Methods Clinical date was retrospectively analyzed in 28 cases of severe traumatic brain injury combined with brain herniation. There were 19 cases with bilateral pupil divergence,and 9 cases with one side pupil divergence before surgery which suffered encephalocele during surgery. In the 9 cases,4 cases was diagnosed contrlateral hematoma and 5 cases was diagnosed diffuse brain swelling by CT scan. All the patients were treated by bilateral standard decompressive craniectomy with large bone flap resection,combined with mild hypothermia during perioperative period. Result According to GOS,there were 6 cases recovered well,3 cases became moderately disabled,4 cases severely disabled,11 cases in vegetative state and 4 cases died. The mortality rate was 14. 3 %. Conclusions Bilateral standard decompressive craniectomy with large bone flap resection combine with mild hypothermia as soon as possible can significantly reduce ICP and decrease mortality rate for the severe traumatic brain injury patients with brain herniation in dangerous conditions of high mortality.