颅脑外伤术中急性脑膨出23例临床分析

Clinical Analysis of 23 Cases of Acute Encephalocele During Craniocerebral Trauma

目的探讨颅脑外伤手术后急性脑膨出的处理。方法回顾性分析我院2016年5月至2017年4月我院收治的颅脑外伤术中出现急性脑膨出的23例的临床资料,采取额颞顶标准大骨瓣行开颅手术治疗的方式,在术中配合使用过度换气、控制性降压等措施。结果本次患者中,行单侧大骨瓣减压的为7例,双侧16例;患者中术后因为脑膨出难以控制后行非功能区减压2例,其中颞极1例,额极1例。本次研究的23例中死亡11例,死亡率为47.83%。存活的12例采取GOS评分,结果为Ⅰ级1例,占4.35%;Ⅱ级2例,占8.70%;Ⅲ级4例,占17.39%;Ⅳ级3例,占13.04%;Ⅴ级2例,占8.70%。结论在进行颅脑外伤手术过程中,通过及时彻底清除血肿、降低患者颅脑内压以及术中控制收缩压是有效预防术后出现疾病脑膨出的重要手段。而针对术后出现急性脑膨出的病患,则需要迅速进行应急处理,降低颅脑外伤术后患者应出现急性脑膨出所带来的伤亡率以及死亡率。

Objective To investigate the treatment of acute encephalocele after craniocerebral trauma.Methods The clinical data of 23 patients with acute encephalocele during craniocerebral trauma in our hospital from May 2016 to April 2017 were analyzed retrospectively,to take the front of the standard large bone flap craniotomy Treatment of the way,in conjunction with the use of excessive ventilation,controlled hypotension and other measures.Results In this patient,the unilateral large bone flap decompression in 7 cases,bilateral 16 cases;patients after surgery because of brain swelling difficult to control non-functional area after decompression in 2 cases,of which the temporal 1 case,1 pole.The study of 23 patients died in 11 cases,the mortality rate was 47.83%.The survival rate of the 12 patients with GOS score,the results of grade Ⅰ 1 case,accounting for 4.35%;Ⅱ grade 2 cases,8.70%;Ⅲ grade 4 cases,accounting for 17.39%;Ⅳ grade 3 cases,13.04%;V grade 2 cases,accounting for 8.70%.Conclusion In the process of craniocerebral trauma,it is an important means to prevent the postoperative brain blast of the disease by reducing the hematoma and reducing the intracranial pressure and intraoperative control of systolic blood pressure.And for patients with acute encephalocele after surgery,you need to quickly carry out emergency treatment,reduce the brain at night negligent patients should be acute brain swelling caused by the mortality rate and mortality.