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目的探讨重型颅脑损伤开颅术中急性脑膨出的形成原因及防治措施。方法对32例重型颅脑损伤开颅术中急性脑膨出的原因、对策及预后进行回顾性分析,比较各种防治措施的疗效。结果按GOS标准,治疗后6个月评定治疗效果,恢复良好12例,中度残疾8例,重度残疾7例,死亡5例。结论术中迟发性颅内血肿形成、急性弥漫性脑肿胀、脑组织缺氧和低血压、长时间脑疝、严重脑挫裂伤等是颅脑损伤术中急性脑膨出的主要原因,正确判断脑膨出的性质,针对不同病因采取相应措施,可防治颅脑损伤术中脑膨出,降低重残率及病死率,取得良好疗效。
Objective To investigate the causes and preventive measures of acute brain bulge in craniocerebral injury patients with severe craniocerebral injury. Methods Retrospective analysis was made on the causes, countermeasures and prognosis of 32 cases of acute brain encephalocele in craniocerebral injury during severe craniocerebral injury. The curative effects of various preventive measures were compared. Results According to the GOS standard, the curative effect was evaluated 6 months after the treatment, with good recovery in 12 cases, moderate disability in 8 cases, severe disability in 7 cases and death in 5 cases. Conclusions Intraoperative delayed intracranial hematoma formation, acute diffuse brain swelling, cerebral hypoxia and hypotension, prolonged cerebral hernia, severe cerebral contusion and laceration are the main causes of acute intracerebral encephalocele during craniocerebral injury. Correctly determine the nature of encephalocele, take measures for different causes, can prevent intracranial encephalocele injury, reduce severe disability and mortality, and achieved good results.