中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2012年
10期
1054-1056
,共3页
张春雷%王玉海%蔡桑%杨理坤%朱军%王剑超%陈磊%李敏%陈卫良%蔡学见
張春雷%王玉海%蔡桑%楊理坤%硃軍%王劍超%陳磊%李敏%陳衛良%蔡學見
장춘뢰%왕옥해%채상%양리곤%주군%왕검초%진뢰%리민%진위량%채학견
外伤性弥漫性脑肿胀%临床分型%颅内压%外科手术
外傷性瀰漫性腦腫脹%臨床分型%顱內壓%外科手術
외상성미만성뇌종창%림상분형%로내압%외과수술
Posttraumatic diffuse brain swelling%Clinical classification%Intracranial pressure%Surgical procedures,operative
目的 探讨外伤性急性弥漫性脑肿胀的临床分型及治疗.方法 将45例头颅CT诊断为外伤性急性弥漫性脑肿胀患者入院后即行颅内压(ICP)监测,依据ICP初始值确定弥漫性脑肿胀患者的临床分型及相应的治疗策略,并对开颅手术者术前及术后ICP值行两样本配对t检验.结果 45例中33例ICP初始值＞35 mmHg,其中31例行开颅手术,1例因ICP过高放弃手术,1例经甘露醇脱水后ICP稳定在30mmHg以下而行保守治疗,死亡18例,植物生存3例,重残2例,中残2例,良好8例；初始ICP＞ 25～ 35mmHg者6例,其中3例行开颅手术,植物生存1例,中残1例,良好4例；初始ICP15 ～ 25mmHg者6例,均保守治疗,植物生存1例,良好5例.开颅前后ICP值变化差异有统计学意义(P＜0.01).结论 依据ICP初始值,外伤性弥漫性脑肿胀可以分为重度颅高压型( ICP＞ 35mmHg),中度颅高压型(ICP＞ 25 ～ 35mmHg),轻度颅高压型(ICP15 ～ 25mmHg)；早期ICP监测对指导外伤性急性脑肿胀患者的治疗有积极作用.
目的 探討外傷性急性瀰漫性腦腫脹的臨床分型及治療.方法 將45例頭顱CT診斷為外傷性急性瀰漫性腦腫脹患者入院後即行顱內壓(ICP)鑑測,依據ICP初始值確定瀰漫性腦腫脹患者的臨床分型及相應的治療策略,併對開顱手術者術前及術後ICP值行兩樣本配對t檢驗.結果 45例中33例ICP初始值＞35 mmHg,其中31例行開顱手術,1例因ICP過高放棄手術,1例經甘露醇脫水後ICP穩定在30mmHg以下而行保守治療,死亡18例,植物生存3例,重殘2例,中殘2例,良好8例；初始ICP＞ 25～ 35mmHg者6例,其中3例行開顱手術,植物生存1例,中殘1例,良好4例；初始ICP15 ～ 25mmHg者6例,均保守治療,植物生存1例,良好5例.開顱前後ICP值變化差異有統計學意義(P＜0.01).結論 依據ICP初始值,外傷性瀰漫性腦腫脹可以分為重度顱高壓型( ICP＞ 35mmHg),中度顱高壓型(ICP＞ 25 ～ 35mmHg),輕度顱高壓型(ICP15 ～ 25mmHg)；早期ICP鑑測對指導外傷性急性腦腫脹患者的治療有積極作用.
목적 탐토외상성급성미만성뇌종창적림상분형급치료.방법 장45례두로CT진단위외상성급성미만성뇌종창환자입원후즉행로내압(ICP)감측,의거ICP초시치학정미만성뇌종창환자적림상분형급상응적치료책략,병대개로수술자술전급술후ICP치행량양본배대t검험.결과 45례중33례ICP초시치＞35 mmHg,기중31례행개로수술,1례인ICP과고방기수술,1례경감로순탈수후ICP은정재30mmHg이하이행보수치료,사망18례,식물생존3례,중잔2례,중잔2례,량호8례；초시ICP＞ 25～ 35mmHg자6례,기중3례행개로수술,식물생존1례,중잔1례,량호4례；초시ICP15 ～ 25mmHg자6례,균보수치료,식물생존1례,량호5례.개로전후ICP치변화차이유통계학의의(P＜0.01).결론 의거ICP초시치,외상성미만성뇌종창가이분위중도로고압형( ICP＞ 35mmHg),중도로고압형(ICP＞ 25 ～ 35mmHg),경도로고압형(ICP15 ～ 25mmHg)；조기ICP감측대지도외상성급성뇌종창환자적치료유적겁작용.
Objective To investigate the clinical classification and the appropriate treatment strategies for posttraumatic acute diffuse brain swelling.Methods A retrospective study was performed in 45 patients with posttraumatic acute diffuse brain swelling who were confirmed on a CT scan,all of them were monitored intracranial pressure (ICP) after admission,and then determine the clinical classification and the corresponding treatment strategies in accordance with the initial ICP value,and compared the preoperative -postoperative ICP value of patients who underwent craniectomy through Two - sample t - test.Results Initial ICP value were greater than 35mmHg in 33 out of 45 patients,31 cases underwent craniectomy,one case was failed to surgery because of excessive high ICP,one case underwent conservative treatment because the ICP less than 30mmHg after giving bolus intravenous infusions of mannitol.33 patients had different outcome including 18 cases who died,three remained in a vegetative state,two with severe deficits,one with moderate deficits,eight with a good recovery ; 6 cases ( ICP ＞ 25 ～ 35 mmHg) had different outcome including one with vegetative state,one with severe deficits,four with a good recovery,3 of them underwent craniectomy; 6 cases (ICP15 ～25 mmHg) had different outcome including one with vegetative state,five with a good recovery,all of them underwent conservative treatment.Conclusions It can be divided into three types for posttraumatic diffuse brain swelling in accordance with the initial ICP value including severe intracranial hypertension type ( ICP ＞ 35 mmHg) ; moderate intracranial hypertension type ( ICP ＞ 25 ～ 35 mmHg) ; mild intracranial hypertension type (ICP15 ～25 mmHg) ; Early ICP monitoring has a positive effect to determine the treatment of patients with posttraumatic acute brain swelling.
