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目的总结52例重型颅脑损伤患者的整体救治经验,探讨重型颅脑损伤的救治方法。方法 2004年9月-2009年9月收治52例重型颅脑损伤患者,男性42例,女性10例;年龄11～75岁,平均年龄40.6岁。开放损伤8例,闭合损伤44例。格拉斯哥昏迷评分(Glasgow coma scale,GCS)3～5分12例,6～8分40例。采用非手术12例,予以脱水、镇静剂、早期行气管切开、鼻饲及防治并发症等治疗。手术40例,行开颅手术清除血肿或去骨瓣减压,其中行单侧手术35例,双侧手术2例,后颅窝手术3例。二次手术1例,5例与其他专科同时手术。结果患者获随访2～24个月。手术治疗组死亡9例(22.5%),非手术组死亡8例(66.7%);本组总死亡率32.7%,存活35例(67.3%)。按GCS预后分级:良好20例(38.5%),中残9例(17.3%),重残6(11.5%)。植物人1例。结论对重型颅脑损伤患者的救治,应提高院前现场救治措施,尽早开颅充分减压,维持循环、内环境稳定,尽早气管切开改善通气;控制感染,防治并发症,尽早(管喂)饮食,积极全身支持;尽早配合中医中药、理疗、体疗等,可改善患者的预后,提高救治成功率。
Objective To summarize the overall treatment experience of 52 patients with severe craniocerebral injury and discuss the treatment of severe craniocerebral injury. Methods From September 2004 to September 2009, 52 patients with severe craniocerebral injury were admitted. There were 42 males and 10 females, aged from 11 to 75 years with a mean age of 40.6 years. Open injury in 8 cases, closed injury in 44 cases. Glasgow coma scale (Glasgow coma scale, GCS) 3 to 5 in 12 cases, 6 to 8 points in 40 cases. Non-operation in 12 cases, to be dehydrated, sedatives, early tracheotomy, nasal feeding and prevention of complications such as treatment. Forty cases underwent craniotomy for hematoma removal or decompressive craniectomy, including 35 cases of unilateral surgery, 2 cases of bilateral surgery and 3 cases of posterior fossa surgery. 1 case of secondary surgery, 5 cases of surgery with other specialties. Results Patients were followed up for 2 to 24 months. Surgical treatment group died in 9 cases (22.5%), non-surgical group died in 8 cases (66.7%); the total mortality rate was 32.7%, 35 cases survived (67.3%). Grading by GCS prognosis: good in 20 cases (38.5%), moderate residual in 9 cases (17.3%), severe disability 6 (11.5%). 1 case of vegetative. Conclusion The treatment of patients with severe craniocerebral injury should improve the premedicated site treatment measures, craniotomy adequate decompression, maintain the circulation, the internal environment stable, early tracheostomy to improve ventilation; infection control and prevention of complications as early as possible (tube feeding ) Diet, active whole body support; as early as possible with traditional Chinese medicine, physical therapy, physical therapy, etc., can improve the prognosis of patients and improve the success rate of treatment.