CAJ | 학술논문

目的分析重型颅脑损伤开颅术后大面积脑梗死发生的相关因素及治疗效果. 方法选择东莞市石碣医院神经外科自2002年1月至2008年4月收治的重型颅脑损伤行开颅术治疗的332例患者,其中术后出现大面积脑梗死20例,回顾性分析术后出现或未出现大面积脑梗死这两类患者术前GCS评分,出血量,颅底骨折,瞳孔变化,是否有脑疝存在及持续时间情况;采用标准大骨瓣减压术治疗及常规综合治疗,并对其疗效进行评价. 结果术前GCS评分<5分、颅内出血量60 mL以上及颅底骨折合并脑疝持续时间长者大面积脑梗死发生率明显增加.本组20例患者随访12月.应用GOS评估预后,其中良好8例,中残3例,重残2例,植物生存3例,死亡4例.结论开颅术后出现大面积脑梗死是多种因素所致,术前GCS评分越低、颅内出血量大、颅底骨折合并脑疝持续时间长是其发生的重要原因;及时发现并行标准大骨瓣减压、脱水降颅内压、改善脑循环、预防脑血管痉挛、亚低温等治疗可有效降低其致残率和病死率.改善预后.
목적 분석중형로뇌손상개로술후대면적뇌경사발생적상관인소급치료효과. 방법 선택동완시석갈의원신경외과자2002년1월지2008년4월수치적중형로뇌손상행개로술치료적332례환자,기중술후출현대면적뇌경사20례,회고성분석술후출현혹미출현대면적뇌경사저량류환자술전GCS평분,출혈량,로저골절,동공변화,시부유뇌산존재급지속시간정황;채용표준대골판감압술치료급상규종합치료,병대기료효진행평개. 결과 술전GCS평분<5분、로내출혈량60 mL이상급로저골절합병뇌산지속시간장자대면적뇌경사발생솔명현증가.본조20례환자수방12월.응용GOS평고예후,기중량호8례,중잔3례,중잔2례,식물생존3례,사망4례.결론 개로술후출현대면적뇌경사시다충인소소치,술전GCS평분월저、로내출혈량대、로저골절합병뇌산지속시간장시기발생적중요원인;급시발현병행표준대골판감압、탈수강로내압、개선뇌순배、예방뇌혈관경련、아저온등치료가유효강저기치잔솔화병사솔.개선예후.
Objective To analyze the factors related to the occurrence of extensive cerebral infarction following surgeries for severe head injury and analyze the clinical outcomes of the patients. Methods Twenty patients with extensive cerebral infarction following surgeries for severe head injury were retrospectively analyzed for preoperative Glasgow Coma Scale (GCS) scores, hemorrhage volume, skull base fracture, pupil size, presence and duration of cerebral hernia. All the patients were treated with standard large bone flap decompression and/or routine comprehensive treatments. Results Patients with preoperative GCS score less than 5, intraeranial hemorrhage over 60 mL, and skull base factures complicated by prolonged cerebral hernia had significantly increased incidence of cerebral infarction. The 20 patients were followed up for 12 months and their clinical outcomes were evaluated with Glasgow Outcome Scale (GOS), which showed good recovery in 8 cases, moderate disability in 3 cases, severe disability in 2 cases, and vegetative survival in 3 cases. Death occurred in 4 cases. Conclusion Multiple factors may contribute to extensive cerebral infarction following surgery for severe head injury, among which low preoperative GCS score, massive intracranial hemorrhage, and prolonged skull base fracture with cerebral hernia are highly risk factors. Early detection of the infarction and timely management with decompression, dehydration, intracranial pressure control, promoting brain circulation, prevention of cerebral vasospasm, and mild hypothermia treatment may help lower the disability and mortality rates of the patients.