颅脑损伤患者开颅术中急性脑膨出的原因及预防策略  

Causes and prevention strategies of acute encephalocele in patients with traumatic brain injury during craniotomy

作　　者：印晓鸿[1] 王远传[1] 段劫[1] 唐晓平[1] 罗仁国[1] YIN Xiao hong;WANG Yuan chuan;DUAN Ji;TANG Xiao ping;LUO Ren guo(Department of Neurosurgery, Affiliated Hospital of North Sichuan Medical College,Sichuan 637000,China)

机构地区：[1]四川省川北医学院附属医院神经外科,南充637000

出　　处：《中国急救复苏与灾害医学杂志》2019年第2期140-142,共3页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的分析颅脑损伤(traumatic brain injury,TBI)患者开颅术中急性脑膨出原因,探讨预防策略。方法以2014年3月-2015年10月在川北医学院附属医院接受治疗的TBI患者为研究对象。根据其术中是否出现脑膨出分为膨出组(35例)和未膨出组(65例)。观察不同临床特征患者术中急性脑膨出的发生情况,分析影响术中脑膨出的因素;进而探讨其预防策略。结果两组患者手术前NIHSS评分无明显差别,治疗后两组患者的NIHSS评分均降低,且未膨出组降低更明显,差异有统计学意义;年龄较大、复合伤、颅内血肿量较大、出现脑积水、对侧合并硬膜外血肿、对侧合并硬膜下血肿的患者手术中出现急性脑膨出的机率较大较高(P<0.05);颅内血肿量、脑积水、对侧合并硬膜下血肿进入回归方程,说明血肿量、是否合并脑积水和对侧合并硬膜下血肿是患者术中发生急性脑膨出的危险因素。结论TBI患者开颅术中急性脑膨出的发生与颅内血肿量和脑积水情况有关,且术中急性脑膨出的发生对患者的预后影响明显。Objective To analyze the causes of acute encephalocele,in patients with traumatic brain injury (TBI) during craniotomy,explore the prevention strategies.Methods A total of 100 cases treated TBI who were admitted at the hospital inbetween March 2014 and October 2015 were included in this study.All patients were divided into two groups according to the intraoperative encephalocele:prolapse group (35 cases)and non-prolapse group (65 cases). The occurrence of acute encephalocectomy in patients with different clinical features were observed,the factors that affect the expansion of intraoperative brain were analyzed.Results There was no significant difference in the NIHSS scores of the two groups before operation.The NIHSS scores of the two groups were all decreased after treatment and there was significant decrease in non-prolapse group as compared with prolapse group (P <0.05),the difference was statistically significant.Older age,combined injury,intracranial hematoma,hydrocephalus,large amount of side with acute encephalocele with contralateral epidural hematoma,subdural hematoma in patients with greater probability were higher,the difference was statistically significant (P <0.05).Intracranial hematoma volume,hydrocephalus, combined with contralateral subdural hematoma that entered the regression equation,the hematoma volume,with hydrocephalus and contralateral combined subdural hematoma were risk factors for acute encephalocele occurred in TBI patients.Conclusion The incidence of acute encephalocele during craniotomy in patients with TBI was associated with intracranial hematoma volume and hydrocephalus,and the occurrence of acute encephalocele during operation had a significant effect on the prognosis of patients.

关 键 词：重型颅脑损伤 脑膨出 危险因素 血压 血气分析 

分 类 号：R651.15[医药卫生—外科学]