容易被忽略的严重颅脑损伤—侧裂静脉伤  

Traumatic Sylvian vein injury: easily neglected severe traumatic brain injury

作　　者：李安民 李钢 张志文[2] 傅相平[2] 史克珊[3] 金虎[3] 陈晓东[3] 

机构地区：[1]解放军总院海南分院神经外科,海口572013 [2]解放军总医院第一附属医院神经外,北京100048 [3]海口市人民医院神经外科,572020

出　　处：《中国临床神经外科杂志》2014年第2期71-73,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的总结创伤性侧裂静脉损伤的治疗经验。方法回顾性分析113例伴有侧裂静脉损伤的重型、特重型颅脑损伤患者的临床资料,保守治疗102例,手术治疗11例,所有患者均给足量蛋白治疗。结果 89.93%侧裂静脉伤为车祸致伤或枕部着地的对冲伤。伤后6个月的GOS评分:死亡37例(32.74%),植物生存12例(10.62%),中残和重残56例(49.56%),恢复良好8例(7.08%)。结论侧裂静脉伤是一种容易被忽略的危重伤,其典型过程是伤后早期发生的同侧或双侧弥漫性脑肿胀,渗透性脱水药疗效差;后期容易发生大体积脑梗死或软化,患者死残率高;强调应在脑疝前行大骨瓣减压术,并对侧裂静脉区进行充分减压;应用足量白蛋白能有效缓解脑肿胀。Objectives To analyze the mechanism of traumatic Sylvian vein injury, and enhance the attention to its effect on the formation of diffuse cerebral swelling and to its treatment. Method The clinical data, especially treatment measures, of 113 patients with severe, especially severe head injury accompanied by Sylvian vein injury were analyzed retrospectively. Results The patients with brain injury caused by traffic accident and ones with contrecoup injury caused by the cerebral occiput touching the ground accounted for 89.38% of these 113 patients, of whom, 8 （7.08%） were recovered well, 56 （49.56%） were mediately and severely disabled, 12 （10.62%） survived vegetatively and 37 （32.74%） died. Conclusions The Sylvian vein injury, which is often neglected, is a serious injury. The effect of osmotic dehydration drug on the ipsilateral or bilateral diffuse cerebral swelling caused by the Sylvian vein injury at the early stage of the injury is poor. The large volume of cerebral infarction or cerebromalacia occurred in the patients with Sylvian vein injury, in whom there are high rates of mortality and disability. The treatment measures include standard large trauma cranioctomy before the cerebral herniation for the full decompression of the brain, and the venous infusion of the sufficient amount of albumin which may be effectively relieve intractable cerebral edema.

关 键 词：颅脑损伤 脑静脉伤 侧裂静脉伤 治疗 

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