摘要
目的探讨颅脑外伤患者开颅术中发生急性脑膨出的分型及综合治疗。方法回顾我院自2008年5月至2010年5月的545例脑外伤开颅患者，对其术中发生脑膨出的132例患者分五型，对侧硬膜外血肿型（Ⅰ型）；窦汇区硬膜外血肿型（Ⅱ型）；对侧额颞部硬膜下血肿、脑挫裂伤型（Ⅲ型）；大面积脑梗死型（Ⅳ型）；弥漫性脑肿胀型（Ⅴ型）。分析各型临床特点，采用综合治疗措施。结果根据伤后6个月GOS预后评分判断患者预后，Ⅰ型：GOS1分14例，GOS2、3分2例，GOS4、5分12例；Ⅱ型：GOS1分7例，GOS2、3分3例，GOS4、5分2例；Ⅲ型：GOS1分14例，GOS2、3分4例，GOS4、5分2例；Ⅳ型：GOS1分18例，GOS2、3分4例，GOS4、5分3例；Ⅴ型：GOS1分44例，GOS2、3分3例，GOS4、5分0例。经过Ridit分析，认为五型之间的预后差异有高度的统计学意义（He=38．53，P＜0．01）。结论颅脑外伤术中脑膨出的分型能反映临床特点及预后，对临床治疗有指导意义，并可提高早期预后判断的准确性和可靠性。
Objective To explore the type and comprehensive treatment of acute Intraoperative encephaloeele in eraniotomy of brain injury patients. Methods 545 cases of craniotomy patients were analyzed retrospectively from May 2008 to May 2010. 132 cases with intraoperative encephalocele were divided into five types, contralateral epidural hematoma （ type Ⅰ）, posterior fossa epidural hematoma （ type Ⅱ ）, contralateral subdural hematoma and contusion （ type Ⅲ ） , traumatic cerebral infarction a （ type Ⅳ ）, Acute diffuse brain swelling （ type Ⅴ ） . Clinical features of various types and integrated treatments were analyzed. Results GOS in 6 months post injury was used to judge the prognosis. 14 patients were GOS 1, 2 patients were GOS 2,3, 12 patients were GOS 4,5 in type Ⅰ ; 7 patients were GOS 1,3 patients were GOS 2,3, 2 patients were GOS 4,5 in type Ⅱ ; 14 patients were GOS 1, 4 patients were GOS 2,3, 2 patients were GOS 4,5 in type Ⅲ ; 18 patients were GOS 1,4 patients were GOS 2,3, 3 patients were GOS 4,5 in type Ⅳ; 44 patients were GOS 1, 3 patients were GOS 2,3, 0 patients were GOS 4,5 in type Ⅴ. The prognosis of five types of encephaloeele have a high degree statistical significance by Ridit analysis （ He = 38. 53, P 〈 0. 01 ）. Conclusion The type of intraoperative encephaloeele can reflect the clinical features and prognosis, to play an important guiding role for clinical treatment, and to improve the accuracy and reliability of judging the early prognostic in traumatic brain injury patients.
出处
《中华神经外科杂志》
CSCD
北大核心
2012年第2期123-127,共5页
Chinese Journal of Neurosurgery
关键词
外伤性脑损伤
脑膨出
外伤性脑梗死
脑肿胀
Traumatic brain injury
Eucephalocele
Traumatic cerebral infarction
Brain swelling
