84例创伤性颅脑损伤脑疝患者临床治疗效果分析  

Clinical outcomes of 84 cases of traumatic brain hernia

作　　者：黄文强[1] 王东华[1] 朱盛[1] 李友富[1] 

机构地区：[1]大竹县人民医院神经外科,四川635100

出　　处：《创伤外科杂志》2012年第6期505-507,共3页Journal of Traumatic Surgery

摘　　要：目的了解颅脑损伤脑疝持续时间与预后的关系,总结发生脑疝病人的手术治疗效果及经验。方法分析我科2008年1月～2011年12月收治的84例发生颅脑损伤脑疝病人的临床资料,男性56例,女性28例;年龄6～88岁,平均42.7岁。其中<18岁5例,18～60岁57例,>60岁22例。致伤原因:道路交通伤31例,摔伤36例,其他暴力伤17例。临床表现:本组病例术前格拉斯哥昏迷量表(GCS)评分为3～7分,其中GCS 6～7分28例,4～5分37例,3分19例。术前单侧瞳孔散大62例,双侧22例。根据临床表现及CT扫描检查确诊为颅脑损伤脑疝,分析单双侧脑疝、脑疝持续时间与预后的关系。制定急救预案,优化流程,行改良骨瓣减压术,术后给予颅内压(ICP)监护、亚低温治疗等综合治疗。结果采用格拉斯哥评分(GOS)标准评做,其疗效为恢复良好28例(33.33%),中残24例(28.57%),重残或植物生存14例(16.67%),死亡18例(21.43%),术后发生大脑后动脉梗塞11例,GCS分值越高、对脑疝行手术减压越好,预后越好。结论对颅脑损伤脑疝病人应争分夺秒手术治疗,并在术后进行有效的监测指导治疗,才能降低病人的死亡及致残率。Objective To investigate the relationship between cerebral hernia following craniocerebral injury and prognosis, and to summarize the effects and experience of surgery in the brain hernia patients. Methods Data of 84 traumatic brain hernia patients hospitalized in our department from Jan. 2008 to Dec. 2011 were analyzed. There were 56 males and 28 females;age ranged from 6-88 years, with an average of 42.7 years. Five patients were less than 18 years old,57 patients 18-60 years old, and 22 patients more than 60 years old. The injury causes analysis indicated 31 cases of road accident injury,36 cases of falling injury, 17 cases of other injury. Preoperative Glasgow Coma Scale （GCS） indicated score ranging from 3-7 ,including 28 cases of 6-7 scores,37 cases of 4-5 scores, 19 cases of 3 scores. During preoperation, unilateral mydriasis was found in 62 cases, bilateral mydriasis in 22 cases. The diagnosis was based on clinical and imaging manifestations, emergency protocols were developed, protocols were optimized and improved decompressive-craniectomy was then performed. After surgery, all patients were treated by the combined therapy of intra-cranial pressure monitor and mild hypothermia therapy. Results Totally 28 cases achieved good recovery （33.33%） ,24 cases （28.57%） mild disability, 14 cases severe disability or plant survival （16.67% ）, 18 cases deaths （21.43%）. Posterior cerebral artery infarction occurred in 11 cases. Better effect could be achieved when surgical decompression was performed for cerebral hernia patients with higher GCS score, resulting in better prognosis. Conclusion In order to reduce the patient ＇s death and disability,traumatic brain hernia patients should be operated immediately and be effective monitoring performed after surgery treatment.

关 键 词：颅脑损伤 脑疝 减压术 颅内压 

分 类 号：R651.1[医药卫生—外科学]