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目的探讨重型颅脑损伤术中急性脑膨出原因、对策。方法回顾性分析2013年8月—2015年7月收治的重型颅脑损伤术中急性脑膨出患者45例的临床资料,分析重型颅脑损伤术中急性脑膨出原因并探讨对策。结果 45例患者急性脑膨出病因:23例迟发性颅内血肿,12例弥漫性脑肿胀,4例外伤性大面积脑梗死,3例长时间脑疝(>2h),3例术中低氧血症或低血压。术后随访6个月,根据GOS(格拉斯哥预后量表)评价患者预后,17例(37.77%)恢复良好,5例(11.11%)中残,3例(66.67%)中残,4例(8.89%)植物生存,16例(35.56%)死亡。结论术前应结合患者仔细分析颅脑CT检查结果、结合病史,提高对急性脑膨出危险因素的预见性,术中加强管理,降低急性脑膨出发生风险,降低重型颅脑损伤致残率及病死率。
Objective To investigate the causes and countermeasures of acute cerebral edema in severe craniocerebral injury. Methods The clinical data of 45 patients with acute encephalocele undergoing severe craniocerebral injury admitted from August 2013 to July 2015 were retrospectively analyzed. The causes of acute encephalocele during severe craniocerebral injury were analyzed and the countermeasures were discussed. Results The causes of acute encephalocele in 45 patients were: delayed encephalic hematoma in 23 cases, diffuse brain swelling in 12 cases, massive traumatic cerebral infarction in 4 cases, prolonged cerebral hernia in 3 cases (> 2 hours) and intraoperative Hypoxemia or hypotension. The prognosis was evaluated according to GOS (Glasgow Outcome Scale), 17 cases (37.77%) recovered well, 5 cases (11.11%) were disabled, 3 cases (66.67%) were disabled, and 4 cases %) Plant survival, 16 patients (35.56%) died. Conclusions Patients should be carefully analyzed before surgery combined with the results of brain CT examination, combined with medical history, to improve the predictability of risk factors for acute encephalocele, intraoperative management to reduce the risk of acute encephalocele and reduce the disability rate of severe craniocerebral injury And fatality rate.