颅脑手术后迟发性脑水肿的临床分析  

Clinical analysis of delayed cerebral edema after craniocerebral operation

作　　者：向定朝[1] 董吉荣[1] 蔡桑[1] 蔡显锋 王玉海[1] XIANG Ding-chao;DONG Ji-rong;CAI Sang(Department of Neurosurgery, No.904 Hospital of the Chinese People's Liberation Army Joint Support Force, Wuxi 221400, China)

机构地区：[1]中国人民解放军联勤保障部队第904医院神经外科,无锡221400

出　　处：《临床神经外科杂志》2020年第2期208-211,共4页Journal of Clinical Neurosurgery

基　　金：全军医药卫生科研基金(10Z004)。

摘　　要：目的探讨颅脑术后迟发性脑水肿的临床、影像学特征及治疗与效果。方法回顾性分析中国人民解放军联勤保障部队第904医院神经外科2015年1月—2017年12月期间收治的8例颅脑手术后发生迟发性脑水肿患者的临床资料。其中颅脑创伤4例,高血压脑出血4例。分析患者的临床表现、影像学特征、手术及术后治疗、病情转归。结果4例颅脑创伤及3例脑出血患者术后发生迟发性脑水肿后,经减少甘露醇使用、改善微循环及糖皮质激素等综合治疗,均完全治愈。1例高血压脑出血患者术后1.5个月诊断为脑脓肿,给予脓肿腔置管引流及抗炎治疗,恢复良好。结论颅脑术后迟发性脑水肿CT表现为“指状水肿”,持续时间长达2周以上。其原因可能与长期使用甘露醇、术区炎性反应等因素有关;采用综合治疗的效果满意。Objective To explore the causes of delayed edema after craniocerebral surgery.Methods The clinical data of 8 patients admitted in department of neurosurgery,No.904 Hospital of the Chinese People's Liberation Army Joint Support Force from Jan 2015 to Dec 2017 were analyzed retrospectively.Of 8 patients,4 were craniocerebral injury and 4 hypertensive intracerebral hemorrhage.The clinical manifestations,imaging features,operation and postoperative treatment and conversion of illness of the patients were also analyzed.Results 4 cases of craniocerebral injury and 3 cerebral hemorrhage patients were completely recovered after delayed cerebral edema happened,through treated by reducing the use of mannitol,improving microcirculation,hormone administration and other comprehensive therapy.One patient with hypertensive intracerebral hemorrhage occurred brain abscess after operation one and a half months,whose recovery was good by giving tube drainage and anti-inflammatory treatment.Conclusions Delayed edema after craniocerebral surgery mostly manifested as“finger edema”on CT images,which lasted for more than 2 weeks.It may be related to the long-term use of mannitol and inflammatory reaction in operation area and its effect of comprehensive treatment was satisfactory.

关 键 词：颅脑损伤 脑水肿 甘露醇 炎性反应 

分 类 号：R651.1[医药卫生—外科学]