摘要
目的 分析外伤后急性脑肿胀 (BS)的临床分型及防治措施。 方法 对本院 6 6例脑外伤后脑肿胀患者依据头颅CT分三组 :一侧半球弥漫性肿胀但中线移位≤ 5mm为A组 ,一侧半球弥漫性肿胀且中线移位 >5mm为B组 ,双侧半球弥漫性肿胀为C组 ,同时进行回顾性分析。结果 ( 1)外伤后急性脑肿胀在脑外伤后比较常见 ,临床需及时诊断 ,并注意意识、瞳孔和头颅CT变化 ,掌握急诊手术时机 ;( 2 )手术与非手术治疗生存率 (分别为 5 2 .5 %、46 .2 %)比较 ,差异无显著性意义 (P >0 .0 5 ) ,但A、B、C三组手术治疗生存率分别为 80 .0 %、6 8.4%和 2 5 .0 %(P <0 .0 1) ,A组良好率、死亡率 (分别为 47.8%、39.1%)与C组 (分别为 8.7%、78.3 %)比较 ,差异有非常显著性意义 (P <0 .0 1)。提示疗效与临床分型有关 ;( 3)加强包括保持呼吸道通畅、维持内环境稳定、充分给氧、脱水、选择性亚低温治疗、纳洛酮和尼莫地平应用、支持对症等综合措施 ,生存率为 5 0 .0 %。 结论 依据临床分型进行选择性综合治疗是提高急性脑肿胀生存率的关键。
Objective To investigate the clinical typing of acute post-traumatic brain swelling (BS) and the prophylactico-therapeutic measures. Methods A retrospective study was performed in 66 cases with acute post-traumatic BS who were divided into 3 groups bases on CT scanning: 23 cases with hemisphere brain swelling (HBS) plus middle line shift for less than 5 mm within 24 hours (Group A), 20 patients with middle line shift for more than 5 mm (Group B), and 23 patients with bilateral brain swelling (Group C, considered as 'DBS' despite of shift). Results ① Acute post-traumatic BS was a common complication in brain injuries and should be diagnosed correctly and promptly with CT scanning within 4 hours so as to give an earlier operation. ② The survival rates of operative and non-operative groups were 52.5% and 46.2% respectively without significant difference (P>0.05), while the post-operative survival rates for Group A, Group B and Group C were 80.0%,68.4% and 25.0% respectively(P<0.01). The recovery rate and the mortality of Group A were 47.8% and 39.1% respectively and that of Group C 8.7% and 78.3% respectively. There was a very significant difference between Group A and Group C (P<0.01), as indicated that the clinical typing was related to the clinical efficiency.③ The total survival rate was 50.0%. The following collective complex measures should be strengthened: to keep respiratory tract unobstructed and homeostatic, to avoid hypoxia and dehydration, and to treat with selective hypothermia and naloxone. Conclusions To apply the selective complex measures according to the clinical typing is key to reducing the mortality of acute post-traumatic BS.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2003年第5期280-282,共3页
Chinese Journal of Trauma
