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目的探讨创伤性脑损伤后发生脑肿胀的原因及防治措施。方法对创伤性脑损伤后发生的65例脑肿胀病人进行回顾性分析。结果按GOS评分评价,5例患者因家属拒绝手术均死亡;手术60例,Ⅰ级死亡28例,存活32例。其中:Ⅱ级植物生存6例,Ⅲ级重残5例,Ⅳ级中残8例,V级良好13例,总死亡率49.2%,术后死亡率46.7%。结论尽早采用大骨瓣开颅术、血肿清除术,术中视情况行额颞极切除术及去大骨瓣减压术,应用巴比妥类药物、亚低温、维持内环境的稳定、防治并发症、神经营养等综合措施,能改善病人的预后,提高救治的成功率;优化急救程序,及早行创伤性脑损伤控制,减少脑组织的二次损伤,是提高救治成功率的关键。
Objective To investigate the causes of brain swelling after traumatic brain injury and its prevention and treatment. Methods 65 cases of brain swelling after traumatic brain injury were retrospectively analyzed. Results According to the GOS score, 5 patients died because of family members refusing surgery. There were 60 cases of surgery, 28 cases of grade Ⅰ death and 32 cases of survival. Among them, Grade II plants survived in 6 cases, Grade III severe disability in 5 cases, Grade IV middle disability in 8 cases, Grade V good in 13 cases, total mortality 49.2% and postoperative mortality 46.7%. Conclusion As soon as possible, craniotomy and hematoma resection were performed. In the course of surgery, frontotemporal pole resection and maxilla flap decompression were performed. Barbiturates and mild hypothermia were used to maintain the stability of the internal environment and to prevent and treat complications Neurological nutrition and other comprehensive measures can improve the patient’s prognosis and improve the success rate of treatment; optimization of emergency procedures, early traumatic brain injury control, reduce secondary damage to brain tissue, is the key to improving the success rate of treatment.