巨大硬膜外血肿术后脑梗塞的预防性治疗  

Postoperative Prophylactic Treatment of Cerebral Infarction in Huge Epidural Hematoma

作　　者：张志强[1] 陈红庆[1] 陈映红[1] 程新富[1] 

机构地区：[1]解放军161中心医院神经外科,湖北武汉430010

出　　处：《武汉大学学报（医学版）》2010年第4期551-554,共4页Medical Journal of Wuhan University

摘　　要：目的:探讨急性重型颅脑外伤中巨大硬膜外血肿病人的手术方法及早期术后治疗对脑梗塞发生的影响。方法:颅脑外伤致巨大硬膜外血肿共108例,A组:60例采用标准外伤大骨瓣开颅术清除血肿减压,B组:48例采用常规去骨瓣开颅术清除血肿减压,A、B组病人根据术后治疗分为治疗组和对照组,各治疗组术后行早期小剂量多次脱水及扩血管治疗,各对照组行大剂量脱水治疗。术后1,3,7 d复查CT。结果:A组病人21例出现脑梗塞,死亡6例,B组病人19例出现脑梗塞,死亡7例,各治疗组脑梗塞分别出现11,10例,各对照组脑梗塞分别出现10,9例。结论:急性重型颅脑外伤中巨大硬膜外血肿病人术后脑梗塞发生率极高,常规去骨瓣开颅术清除血肿减压合并术后早期使用小剂量脱水及扩血管药物可有效减少病人脑梗塞发生率,降低病死率。Objective： To observe the effects of operation and early postoperative treatment on cerebral infarction of huge epidural hematoma patients in acute severe crainocerebral injury.Methods： Of the108 cases of huge epidural hematoma with acute severe crainocerebral injury,60 cases in group A were treated by evacuation of epidural hematoma with large decompressive craniotomies,and the other 48 cases in group B were treated by conventional decompressive craniotomies to evacuate hematoma.All patients were also divided into small dose and large dose dehydrating agent groups which were treated respectively by small-dose and repetitious dehydrating agents and vasodilators after operation,and by large-dose dehydrating therapy after the operation.All cases were performed CT scanning at 1,3,and 7 day（s） after surgery separately.Results： In group A,21 patients presented with cerebral infarction,and 6 patients died.In group B,19 patients presented with cerebral infarction,and 7 patients died.After small dose dehydrating treatment,11 and 10 patients in group A and B respectively presented with cerebral infarction.After large dose dehydrating treatment,10 and 9 patients in group A and B respectively presented with cerebral infarction.Conclusion： The mortality of postoperative cerebral infarction on huge epidural hematoma patients in acute severe crainocerebral injury was extremely high.With conventional decompressive craniotomy,early postoperative administration of small-dose and repetitious dehydrating agents and vasodilators is an effective method,and could markedly decrease the mortality rate.

关 键 词：颅脑外伤 硬膜外血肿 脑梗塞 

分 类 号：R651[医药卫生—外科学]