标准外伤大骨瓣开颅术中急性脑膨出96例临床分析(1)
 |
| 第1页 |
参见附件。
[摘要] 目的：探讨标准外伤大骨瓣开颅术中急性脑膨出的临床特点及救治方法。方法：回顾性分析96例标准外伤大骨瓣开颅术中急性脑膨出患者的临床资料。结果：96例患者中恢复良好21例(21.88%)，中度残疾14例(14.58%)，重度残疾28例(29.17%)，植物生存状态14例(14.58%)，死亡19例(19.79%)，GCS评分越低，术中发生急性脑膨出的程度越高，死亡率越高，组间比较差异有统计学意义(P<0.05)。结论：迟发性颅内血肿和急性脑肿胀是术中急性脑膨出的主要原因，而GCS评分低的患者更容易出现脑膨出，术中应根据受伤机制，术前GCS评分，脑膨出的特点，尽早采取相应措施，以取得较好疗效，降低患者死亡率。
[关键词] 颅脑损伤；重型；减压术；去大骨瓣；脑膨出
[中图分类号] R651.1 [文献标识码] B [文章编号] 1673-7210(2012)01(a)-152-03
Clinical analysis of 96 cases of acute encephalocele in standard large trauma craniotomy
SU Fangwen
Department of Brain Surgery, the People's Hospital of Lengshuijiang City, Hu′nan Province, Lengshuijiang 417500, China
[Abstract] Objective: To investigate the clinical features and treatment methods of acute encephalocele in standard large trauma craniotomy. Methods: Clinical data of 96 cases of acute encephalocele in standard large trauma craniotomy were retrospectively analyzed. Results: Among the 96 patients, 21 cases achieved good to moderate results (21.88%), 14 patients (14.58%) were of moderate disability, 28 cases (29.17%) were of severe disability, 14 cases (14.58%) ended up in vegetative state and 19 cases (19.79%) led to death. The lower the GCS score, the severer intraoperative acute encephalocele and the higher the mortality rate, and the differences between the two groups were significant (P<0.05). Conclusion: The delayed intracranial hematoma and acute brain swelling are the main cause of intraoperative acute encephalocele, with patients of low GCS score, more prone to brain encephalocele. Thus before surgery GCS score of patients and appropriate measures in accordance with the features of encephalocele should be taken to achieve better efficacy and lower patient mortality rate.
[Key words] Brain injury; Severe; Decompression; Large trauma craniotomy; Encephalocele
去大骨瓣减压术(decompressive craniecmy)能有效缓解颅内压，解除脑疝，减少病死率，是抢救重型颅脑损伤及脑疝患者常用的手术方法，它对挽救患者生命起着极其重要的作用[1]。但是大骨瓣减压术容易引起急性脑膨出，一旦出现，会进一步加重脑组织缺血、缺氧及坏死，是神经外科的难题之一，术中处理很棘手，预后差。有文献报道，病死率高达70%[2]。因此如何有效防治脑膨出，降低病死率，很值得学者们探讨。我科于2006年6月~2011年6月共收治此类患者96例，针对术中出现急性脑膨出的原因，采取相应措施，获得良好效果。现总结报道如下：
1资料与方法
1.1一般资料
本组共96例，男65例，女31例，年龄17~72岁，平均42岁。其中，车祸伤62例，高处坠落伤18例，打击伤16例；枕部着力19例，颞顶部着力72例，颌面部着力5例；所有病例均有意识障碍，入院时根据GCS评分3~15分，其中，特重型(3~5分)29例 ......
您现在查看是摘要介绍页，详见PDF附件(2204kb)。