重症颅脑损伤合并胸外伤患者的救治和预后研究  

Research of the Prognosis of Patients with Severe Craniocerebral Injury combined with Thoracic Trauma

作　　者：周贵勤 陈召[2] 毛景涛 王居正[2] 王武平[2] 张继朋[2] 卢强[2] 

机构地区：[1]陕西省森工医院,陕西西安710300 [2]第四军医大学唐都医院胸腔外科,陕西西安710038

出　　处：《现代生物医学进展》2017年第3期470-472,488,共4页Progress in Modern Biomedicine

基　　金：国家自然科学基金项目(81172224)

摘　　要：目的:探讨重症颅脑损伤合并胸外伤患者的临床救治要点和预后。方法:对2006年1月至2015年12月陕西省森工医院收治的重型颅脑损伤及重型颅脑损伤合并胸外伤患者的临床资料进行回顾性研究,并随访观察其预后情况。结果:我院10年间收治单纯重症颅脑损伤患者137例及重症颅脑损伤合并胸外伤患者86例,单纯重症颅脑损伤患者死亡率为9.5(13/137),主要死亡原因为:脑内出血(36/26.3%)、脑挫裂伤(31/22.6%)、呼吸衰竭(27/19.7%)等;重症颅脑损伤合并胸外伤患者死亡率为17.4(15/86),主要死亡原因为:呼吸衰竭(18/20.9%)、脑挫裂伤(18/20.9%)、脑内出血(15/17.4%)等。单纯重症颅脑损伤患者手术时间为187.6±11.3分钟、术后住院时间为10.9±1.8天、肢体运动障碍12例(8.8%)、植物生存2例(1.5%);重症颅脑损伤合并胸外伤患者手术时间为265.4±18.9分钟、术后住院时间为14.3±2.1天、肢体运动障碍10例(11.6%)、植物生存3例(3.5%)。其中,两组间在手术时间、术后住院时间及肢体运动障碍方面有统计学差异。结论:重症颅脑损伤合并胸外伤较单纯重症颅脑损伤的致死率更高,手术时间长,术后并发症发生率更高,术后住院天数较长。对于重症颅脑损伤合并胸外伤的患者,应尽量保全肢体功能,提高患者存活率和术后生活质量。Objective： Analysis of clinical treatment and prognosis of patients with severe craniocerebral injury or combined with thoracic trauma. Methods： The clinical data of patients with severe craniocerebral injury or combined with thoracic trauma from January2006 to December 2015 were retrospectively studied from Shaanxi Provincial Forestry hospital. Results： In our hospital,137 cases of severe craniocerebral injury and 86 cases of severe craniocerebral injury combined with thoracic trauma were treated in our hospital during the past 10 years. The death rate of patients with severe craniocerebral injury was 9.5（13/137）,the main causes of death were： intracerebral hemorrhage（36/26.3%）,brain contusion（31/22.6%）,respiratory failure（27/19.7%） and the mortality rate of patients with severe craniocerebral injury combined with thoracic injury was 17.4（15/86）,the main causes of death were： respiratory failure（18/20.9%）,brain contusion（18/20.9%）,intracerebral hemorrhage（15/17.4%） and so on. The operation time of patients with severe craniocerebral injury was 187.6±11.3 minutes,postoperative hospitalization time was 12±1.8 days,10.9（8.8%） cases of limb movement disorder,2（1.5%）cases of plant survival. The operation time of patients with severe craniocerebral injury combined with thoracic trauma was 265.4 ±18.9minutes,postoperative hospitalization time was 10±2.1 days,14.3（11.6%） cases of limb movement disorder,3（3.5%） cases of plant survival. Among them,there were statistically significant differences in operation time,postoperative hospital stay and limb movement disorder between the two groups. Conclusion： The death rate of severe craniocerebral injury combined with thoracic trauma is higher than that of simple severe craniocerebral injury,the operation time is longer,the incidence of postoperative complications is higher and the length of stay is longer. The limb function of patients with severe craniocerebral injury combined with thoracic trauma should be prese

关 键 词：重症颅脑损伤 胸外伤 救治 预后 

分 类 号：R651[医药卫生—外科学] R655[医药卫生—临床医学]