急性外伤性多发颅内血肿105例手术治疗体会  

Operative management of multiple intracerebral hematoma in patients with acute traumatic brain injury: a retrospective analysis of 105 cases

作　　者：朱蔚林[1] 赵建农[1] 黄垂学[1] 

机构地区：[1]海南省人民医院神经外科,海南海口570311

出　　处：《海南医学》2013年第18期2716-2719,共4页Hainan Medical Journal

基　　金：国家重点临床专科建设项目资助(编号:2011873)

摘　　要：目的探讨急性颅脑损伤多发血肿的手术时机和治疗策略。方法回顾性分析我院2008年10月至2013年2月105例急性外伤性多发颅内血肿手术治疗的临床资料。结果 105例患者中存活91例,死亡14例,其中恢复良好60例,中度伤残14例,重度伤残7例,植物生存10例。结论存在手术指征者尽早手术,脑疝者迅速行标准大骨瓣减压及血肿清除。未脑疝者,如患者意识障碍加重,瞳孔改变,动态头颅CT显示血肿增加或者水肿加重者采取预见性手术。持续ICP监护有助于多发颅内血肿患者的病情观察,指导手术及药物治疗,改善预后。Objective To explore the time and strategy of operative management of multiple intracerebral he- matoma in the patients with acute traumatic brain injury. Methods A total of 105 consecutive patients with acute multiple intracerebral hematoma who underwent surgery were retrospectively analyzed from October 2008 to Febru- ary 2013. Results According to GOS for assessment of outcomes, 91 patients survived （60 survived with good recovery, 14 with moderate disability, 7 with severe disability, 10 with vegetable status）, and 14 patients died. Conclusion Acute multiple intracerebral hematoma should be performed operations for patients with surgical indication as early as possible. The standard decompressive craniectomy and evacuation of hematoma should be performed in the patients with cerebral hernia. Patients whose disturbance of consciousness aggravated, pupillary changed, intracerebral hematoma increased through CT scan need predictable operations. Continous intracranial pressure （ICP） monitoring can effectively assist in observing condition changes, directing the use of medicine or operations and improving the prognosis.

关 键 词：多发颅内血肿 标准大骨瓣减压术 颅脑损伤 急性外伤性 

分 类 号：R651.1[医药卫生—外科学]