急性硬膜下血肿术中脑膨出的原因分析与综合治疗  

Analysis of Cause of Intraoperative Encephalocele and Its Treatment in Patients with Acute Subdural Hematomas

作　　者：李壮志[1] 孙晓辉[1] 孙学东[1] 富壮[2] 刘书深 张学军[1] 

机构地区：[1]威海市立医院神经外科,山东威海264200 [2]北京积水潭医院神经外科,北京100035

出　　处：《中国临床神经外科杂志》2006年第2期80-82,共3页Chinese Journal of Clinical Neurosurgery

基　　金：威海市科技局立项课题080~4

摘　　要：目的探讨急性硬膜下血肿术中脑膨出形成原因及综合治疗措施。方法回顾分析45例术中出现脑膨出的急性硬膜下血肿病人的受伤机制、临床表现、CT扫描结果,总结脑膨出形成原因。结果按GOS标准,治疗后6个月评定治疗结果,恢复良好24例,中残4例,植物生存1例,死亡16例。急性脑肿胀、迟发性颅内血肿、低血压、脑缺氧、长时间脑疝是颅脑术中急性脑膨出的主要原因,采取综合治疗是防治术中脑膨出的有效措施。结论结合临床和CT扫描可判定术中脑膨出发生的可能性,对各种原因所致术中急性脑膨出及时采取相应综合措施可获良效。Objective To explore the cause of acute introperative encephalocele and its comprehensive treatment in the patients with acute subdural hematomas （ASDH）. Methods The injury mechanism, clinical manifestations and CT data of 45 patients with acute encephalocele during the surgery for acute subdural hematomas were analysed retrospectively. While receiving surgery for acute subdural hematomas, the patients with encephalocele received comprehensive （surgical and conservative） treatment for the encepha-locele according their condition. Results According to GOS, of 45 patients with intraoperative encephalocele, 24 were well recovered from their illness, 4 moderately disabled, 1 vegetatively survived and 16 died 6 months after the treatment. The main cause of the in-tra-operative encephalocele included acute brain swelling, delayed intracranial heamatoma, hypotention, cerebral anoxia, long-term brain herniation in the patients with acute subdural hematomas. Conclusions The preliminary diagnosis of acute introperative encepha-locele can be made by the clinical manifestations and CT examination. The introperative encephalocele induced by different causes should be given comprehensive treatment including the surgical and conservative in the patients with acute subdural hematomas.

关 键 词：急性硬膜下血肿 脑膨出 脑肿胀 脑水肿 预后 开颅手术 

分 类 号：R651.15[医药卫生—外科学] R651.11[医药卫生—临床医学]