中国急救医学
中國急救醫學
중국급구의학
CHINESE JOURNAL OF CRITICAL CARE MEDICINE
2001年
5期
268-270
,共3页
颅脑损伤%肝损伤%救治
顱腦損傷%肝損傷%救治
로뇌손상%간손상%구치
目的总结颅脑损伤合并肝损伤救治的经验和教训，探讨影响患者死亡的因素。方法 1993～1999年收治的46例颅脑损伤合并肝损伤的患者根据其临床表现分成3组：Ⅰ组17例为颅脑损伤严重而肝损伤较轻者；Ⅱ组18例为肝损伤严重而颅脑损伤较轻者；Ⅲ组11例为颅脑损伤和肝损伤均严重者。颅脑损伤严重、肝损伤严重者分别行手术治疗，损伤较轻者按非手术治疗。结果Ⅰ组开颅手术17例，肝损伤按非手术治疗，其中3例转手术治疗，病死率为23.5%；Ⅱ组行肝损伤的手术治疗18例，颅脑损伤按非手术治疗，其中4例转手术治疗，病死率为33.4%；Ⅲ组全部手术治疗，病死率为72.7%。显著高于Ⅰ组和Ⅱ组(χ2分别为6.60，5.57，P均＜0.05)。全组病死率为37.0%。结论及早明确诊断；术前积极救治；早期开颅手术解除颅内高压，控制肝脏破裂大出血；掌握非手术治疗的适应证，重视术后处理可降低死亡率。
目的總結顱腦損傷閤併肝損傷救治的經驗和教訓，探討影響患者死亡的因素。方法 1993～1999年收治的46例顱腦損傷閤併肝損傷的患者根據其臨床錶現分成3組：Ⅰ組17例為顱腦損傷嚴重而肝損傷較輕者；Ⅱ組18例為肝損傷嚴重而顱腦損傷較輕者；Ⅲ組11例為顱腦損傷和肝損傷均嚴重者。顱腦損傷嚴重、肝損傷嚴重者分彆行手術治療，損傷較輕者按非手術治療。結果Ⅰ組開顱手術17例，肝損傷按非手術治療，其中3例轉手術治療，病死率為23.5%；Ⅱ組行肝損傷的手術治療18例，顱腦損傷按非手術治療，其中4例轉手術治療，病死率為33.4%；Ⅲ組全部手術治療，病死率為72.7%。顯著高于Ⅰ組和Ⅱ組(χ2分彆為6.60，5.57，P均＜0.05)。全組病死率為37.0%。結論及早明確診斷；術前積極救治；早期開顱手術解除顱內高壓，控製肝髒破裂大齣血；掌握非手術治療的適應證，重視術後處理可降低死亡率。
목적총결로뇌손상합병간손상구치적경험화교훈，탐토영향환자사망적인소。방법 1993～1999년수치적46례로뇌손상합병간손상적환자근거기림상표현분성3조：Ⅰ조17례위로뇌손상엄중이간손상교경자；Ⅱ조18례위간손상엄중이로뇌손상교경자；Ⅲ조11례위로뇌손상화간손상균엄중자。로뇌손상엄중、간손상엄중자분별행수술치료，손상교경자안비수술치료。결과Ⅰ조개로수술17례，간손상안비수술치료，기중3례전수술치료，병사솔위23.5%；Ⅱ조행간손상적수술치료18례，로뇌손상안비수술치료，기중4례전수술치료，병사솔위33.4%；Ⅲ조전부수술치료，병사솔위72.7%。현저고우Ⅰ조화Ⅱ조(χ2분별위6.60，5.57，P균＜0.05)。전조병사솔위37.0%。결론급조명학진단；술전적겁구치；조기개로수술해제로내고압，공제간장파렬대출혈；장악비수술치료적괄응증，중시술후처리가강저사망솔。
Objective To summarize the experiences and lesson in treatment of 46 cases of head injury and liver injury and determine the risk factors for death.Methods From 1993 to 1999,46 patients with head injury and liver injury were treated in our hospital.They were divided into 3 groups according to their clinical status:the 17 cases were severe head injury and mild liver injury patients in Ⅰ group.The 18 cases were severe liver injury and mild head injury patients in Ⅱ group. The 11 cases were severe head injury and severe liver injury patients in Ⅲ guoup.The surgical treatment was for performed of severe head injury and severe liver injury.The no-surgical treatment for patients of mild head injury and mild liver.Results Craniotomy of 17 cases and surgical treatment 3 cases of liver injury transformed from no-surgical treatment in Ⅰ group.Case-fatality rate was of 23.5%.Surgical treatment 18 cases of liver injury and craniotomy 4 cases transformed from no-surgical treatment in Ⅱ group.Cases-fatality rate was 33.4%.The whole patients were surgical treatment in Ⅲ group.Case-fatality rate was 72.7%.The death rate of Ⅲ group is significantly higher than Ⅰ group and Ⅱ group.All groups cases-fatality rate was 37.0%.Conclusions It is recommended that early definite diagnose,active to treatment before operation,early craniotomy for reducing the intracranial hypertension and control massive haemorrhage of hepatorrhexis,mastering indication of no-surgical treatment, to attach importance to post operative treatment can reduce the case-fatality rate.
