【摘要】 目的 探讨重型颅脑损伤的临床特点和救治经验。 方法 回顾性总结2002年1月-2008年12月所诊治重型颅脑损伤96例的临床资料。 结果 96例重型颅脑损伤患者，其中手术治疗59例，非手术治疗37例。按GOS评分，出院时恢复良好33例（34.4%），中残15例（15.6%），重残16例（16.7%），植物生存8例（8.3%），死亡24例（25.0%）。 结论 重型颅脑损伤仍然具有较高的病死率和致残率，早期及时手术清除颅内血肿解除脑疝，早期气管插管或气管切开并呼吸机支持治疗及其它积极恰当的综合治疗措施是抢救治疗成功的关键；后期加强护理注重防治并发症，可以最大可能挽救患者生命。【Abstract】 Objective To explore the clinical characteristics of severe cranio-cerebral injury and its treatment experience. Methods The clinical data of 96 patients with severe cranio-cerebral injury from January 2002 to December 2008 were retrospectively analyzed. Results In 96 patients with cranio-cerebral, 59 had undergone the surgeries and the others had undergone the conservative treatment. According to the Glasgow outcome scale (GOS), 33 (34.4%) had a good outcome, 15 (15.6%) had moderate disability, 16 (16.7%) had severe disability, 8 (8.3%) had vegetative persistent and 24 (25.0%) died. Conclusion The mortality and morbidity rate of the patients with severe cranio-cerebral injury are high, we should clean out the intracranial hematoma and relieve cerebral herniation in time, performed early tracheal intubation or tracheotomy with respirator therapy, and other active and appropriate general therapies, and avoid complications via rehabilitation time intensify nursing to rescue the patients.
Objectives To assess the efficacy and safety of standard trauma craniectomy (STC), compared with limited craniectomy (LC) for severe traumatic brain injury (sTBI) with refractory intracranial hypertension. Methods We searched the Cochrane Central Register of Controlled Trials-Central (The Cochrane Library Issue 3, 2008), MEDLINE (1966 to October 2008), EMbase (1984 to October 2008), CMB-disc (1979 to October 2006) and CNKI (1979 to October 2008) for completed studies, as well as clinical trial registries for ongoing studies and completed studies with unpublished data. The reference of included studies and relevant supplement or conference abstracts were handsearched. The search results were extracted, and then the quality of included studies was assessed using RevMan 5.0. Meta-analysis was conducted if the data was similar enough. Results Two randomized controlled trials (RCTs) involving 716 participants were identified. Compared with the LC group, the STC group had statistically significant, more favorable outcome on the basis of the Glasgow Outcome Scale, using measures such as mortality, efficiency, and survival, compared with those of LC group, which had statistic difference. The mean ICP fell more rapidly and to a lower level in the STC group than in the LC group. There was no statistically significant difference on the incidence of postoperative complications, including delayed hematoma, incision cerebrospinal fluid fistula, encephalomyelocele, traumatic epilepsy, and intracranial infection as well. Conclusion The efficacy of STC is superior to LC for severe TBI with refractory intracranial hypertension resulting from unilateral frontotemporoparietal contusion with or without intracerebral or subdural hematoma.
【摘要】 目的 探讨重型颅脑损伤的死亡原因。方法 对2002年1月—2010年1月收治的54例重型颅脑损伤死亡患者,其受伤原因、受伤至入科时间、损伤时间、临床表现、治疗情况等临床资料进行回顾性分析。结果 原发或继发性颅脑损伤严重、严重的合并伤和术后并发症是死亡的重要因素。结论 重型颅脑损伤患者死亡的原因是多方面的,对此类患者须采取综合救治措施,以降低其死亡率。
目的:探讨行气管切开术抢救成功的重型颅脑损伤及高血压脑出血患者直接除管的安全性和可行性。方法:在507监护仪行SPO2监测和严密观察下,不经过试阻管而直接将气管套管拔除。结果:本组除1例患者因带管时间长,切口周围气管内炎性肉芽生长而重新插管外,其余患者呼吸平稳,呼吸道通畅,无呼吸急促、呛咳、紫绀及SPO2降低。结论:此法避免了传统除管前试阻管的繁锁和由阻管而引起的多种不良反应,有临床实用价值。
目的：评价3%高渗盐水(HS)治疗重型颅脑损伤患者颅内高压的有效性和安全性。方法:回顾性分析了37例重型颅脑损伤患者的临床资料。结果:3% HS治疗组患者ICP降低更为显著,起效时间更快,持续时间更长。HS组患者MAP和CPP升高多于甘露醇组。治疗后,HS患者低钠血症发生率明显低于对照组。结论:3% HS可以考虑作为治疗重型颅脑损伤患者颅内高压的一线药物。
目的:分析重型颅脑损伤患者早期进入ICU进行监护和治疗对预后的影响。方法: 将重型颅脑损伤患者根据是否直接进入ICU分为研究组和对照组,评价3月后患者神经功能和死亡率。结果: 与对照组比较,研究组死亡率更低,3月后ADL分级法生存质量良好率也显著更高。结论: 重型颅脑损伤患者早期进入ICU监护和治疗,可降低术后病死率,改善生存质量。
ObjectiveTo investigate the effects of large trauma craniotomy on severe traumatic brain injury. MethodsA total of 132 cases of severe traumatic brain injury adopted large trauma craniotomy between July 2008 and August 2013, and the clinical data were retrospectively analyzed. ResultsAccording to the results of GOS assessment at discharge, 67 patients (50.75%) were satisfied, 26 (19.70%) were mildly disable, 10 (7.58%) were severely disable, 12 (9.09%) were in vegetative state, and 17 (12.88%) were dead. ConclusionCorrect use of large trauma craniotomy on severe brain injury cases will help to improve the treatment outcome, reduce complications and improve quality of survival.