中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2013年
2期
138-141
,共4页
杨朝华%李鹏程%李强%昝昕%关俊文%李国平%游潮
楊朝華%李鵬程%李彊%昝昕%關俊文%李國平%遊潮
양조화%리붕정%리강%잠흔%관준문%리국평%유조
颅脑创伤%脑疝%去骨瓣减压术%颅内压%预后
顱腦創傷%腦疝%去骨瓣減壓術%顱內壓%預後
로뇌창상%뇌산%거골판감압술%로내압%예후
Craniocerebral trauma%Encephalocele%Decompressive craniectomy%Intracranial pressure%Prognosis
目的 探讨重型颅脑损伤脑疝去骨瓣减压的手术指证及预后因素.方法 收集2009年5月至2011年12月四川大学华西医院神经外科139例重型颅脑损伤脑疝患者的资料,对患者的伤情、手术治疗情况、术后颅内压(ICP)值和预后等进行回顾性分析.结果 去骨瓣减压102例,保留骨瓣37例.其中GCS≤6分的106例中,有85例去骨瓣,占80.1％；双瞳孔散大有88％ (35/40)去骨瓣,单瞳孔散大有68％ (67/99)去骨瓣.伤后3个月GOS评定,死亡42例,植物生存31例,重残16例,中残8例,恢复良好42例,病死率为30.2％(42/139).其中GCS 3分病死率为63％(19/30).双瞳孔散大病死率为60％(24/40),单瞳孔散大病死率为18％ (18/99).术后ICP 30～40 mm Hg病死率为74％(14/19),术后ICP ＞40 mm Hg病死率为100％(8/8).结论 GCS≤6分、双瞳孔散大和术中脑膨出可作为去骨瓣减压的手术指证.GCS评分低、双瞳孔散大、ICP≥30 mm Hg等提示病死率高、预后不良.
目的 探討重型顱腦損傷腦疝去骨瓣減壓的手術指證及預後因素.方法 收集2009年5月至2011年12月四川大學華西醫院神經外科139例重型顱腦損傷腦疝患者的資料,對患者的傷情、手術治療情況、術後顱內壓(ICP)值和預後等進行迴顧性分析.結果 去骨瓣減壓102例,保留骨瓣37例.其中GCS≤6分的106例中,有85例去骨瓣,佔80.1％；雙瞳孔散大有88％ (35/40)去骨瓣,單瞳孔散大有68％ (67/99)去骨瓣.傷後3箇月GOS評定,死亡42例,植物生存31例,重殘16例,中殘8例,恢複良好42例,病死率為30.2％(42/139).其中GCS 3分病死率為63％(19/30).雙瞳孔散大病死率為60％(24/40),單瞳孔散大病死率為18％ (18/99).術後ICP 30～40 mm Hg病死率為74％(14/19),術後ICP ＞40 mm Hg病死率為100％(8/8).結論 GCS≤6分、雙瞳孔散大和術中腦膨齣可作為去骨瓣減壓的手術指證.GCS評分低、雙瞳孔散大、ICP≥30 mm Hg等提示病死率高、預後不良.
목적 탐토중형로뇌손상뇌산거골판감압적수술지증급예후인소.방법 수집2009년5월지2011년12월사천대학화서의원신경외과139례중형로뇌손상뇌산환자적자료,대환자적상정、수술치료정황、술후로내압(ICP)치화예후등진행회고성분석.결과 거골판감압102례,보류골판37례.기중GCS≤6분적106례중,유85례거골판,점80.1％；쌍동공산대유88％ (35/40)거골판,단동공산대유68％ (67/99)거골판.상후3개월GOS평정,사망42례,식물생존31례,중잔16례,중잔8례,회복량호42례,병사솔위30.2％(42/139).기중GCS 3분병사솔위63％(19/30).쌍동공산대병사솔위60％(24/40),단동공산대병사솔위18％ (18/99).술후ICP 30～40 mm Hg병사솔위74％(14/19),술후ICP ＞40 mm Hg병사솔위100％(8/8).결론 GCS≤6분、쌍동공산대화술중뇌팽출가작위거골판감압적수술지증.GCS평분저、쌍동공산대、ICP≥30 mm Hg등제시병사솔고、예후불량.
Objective To present our experiences on the treatment of severe traumatic brain injury on patients with herniation and discuss the indication for decompressive craniectomy (DC) and prognostic factors.Methods From May 2009 to Dec.2011,139 patients aged between 3 and 83 years with severe traumatic cerebral herniation were included.The patients' Glasgow Coma Scale score (GCS),pupil reaction,diagnosis,surgical treatment methods,and prognosis were analyzed retrospectively.Results 102patients underwent DC and 37 patients underwent non-decompressive craniectomy.Amongst 106 patients with GCS≤6,there were 85 patients undergoing DC (80.1％).Thirty-five patients with bilateral pupil dilation underwent DC (88％,35/40),and 67 (68％,67/99) patients with unilateral pupil dilation underwent DC(P ＜0.05).Based on the Glasgow Outcome Scale,42 patients were dead,31 in vegetative state,16 with severe disabilities,8 with moderate disabilities,and 42 had good recovery at the 3-month follow-up.Overall mortality was 30.2％.As for patients with GCS =3,the mortality was 63％ (19/30).Lower GCS was associated with worse outcomes.The mortality was 60％ in 40 patients with bilateral pupil dilation and 18％ in 99 patients with unilateral pupil dilation (P ＜ 0.05).The mortality was 5％ (2/37) in patients with epidural hematoma and 43％ (26/61) with subdural hematoma (P ＜ 0.05).The mortality was 74％ (14/19) when ICP 30 ～40 mm Hg,and the mortality was 100％ (8/8) when ICP ＞40 mm Hg.Conclusions Low GCS,bilateral pupil dilations,and ICP ≥ 30 mm Hg suggest higher mortality and unfavorable outcomes.GCS≤6,bilateral pupil dilations,and intraoperative brain swelling can be viewed as indications for DC in severe traumatic brain injury patients with herniation.Smart surgical technique is helpful for the treatment of herniation.
