对冲性重型颅脑损伤高重复性手术原因分析 （附14 例报告）

白金让，董海昭，尚增强

（凤翔县医院，陕西 宝鸡，721400）

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摘要：

目的 分析对冲性重型颅脑损伤高重复手术治疗原因，积极寻求应对策略，以提高其治愈率、降低残死率。方法 对我院 2013年5月至2016年6月收治的14例对冲性颅脑损伤重复手术患者临床资料（尤其1例特殊病案全程报告）的致伤机制、 首诊时限、格拉斯哥昏迷评分（GCS）及CT片示结果、病情骤变时限、复查情况、处置方式等进行回顾性总结分析。结果 14例 对冲性颅脑损伤手术患者重复手术18 次，根据GOS评分：良好6例，中残3例，重残2例，植物生存1例，死亡2例。治愈率 为42.9%（6/14），残死率为57.1%（8/14）。结论 对冲性急性重型颅脑损伤患者病情凶险、变化急骤、具有高重复手术治疗的特 点，需强化诊治意识、严密监控尽早发现病情变化迹象，建立快捷应急处置通道，提高精准治疗技术是挽救生命、提高其治愈率、降低残死率的有效保障。

关键词：对冲性重型颅脑损伤；高重复性手术；致伤机制

中图分类号：R651.15文献标志码：A文章编号：2096-1413(2017)21-0001-03

Causes analysis of high-repetitive surgeries for contrecoup severe brain injuries (a report of 14 cases)
BAI Jin-rang, DONG Hai-zhao, SHANG Zeng-qiang


(Fengxiang County Hospital, Baoji 721400, China)

ABSTRACT: Objective To analyze the causes of high-repetitive surgeries for contrecoup severe brain injuries, seek coping strategies and improve cure rate, reduce disability and death rate. Methods The clinical data of 14 cases of contrecoup severe brain injuries patients who received repetitive surgeries (including the entire report of one special case) from May 2013 to June 2016 were collected. The data including injury mechanism, first diagnosis time, GCS, CT examination results, apostasis time, reexamination results and treatment methods were summarized and retrospectively analyzed. Results A total of 18 repetitive surgeries were conducted in the 14 patients with contrecoup brain injuries. According to GOS score, 6 patients had good outcome, 3 patients got moderate disability, 2 patients got severe disability, 1 patient got plant survival, and 2 patients died. The cure rate was 42.9% (6/14), while disability and death rate was 57.1% (8/14). Conclusion Patients with contrecoup brain injuries present with dangerous conditions and acute changes, thus require high-repetitive surgeries. Therefore, to strengthen the awareness for diagnosis and treatment, closely monitor changes of the condition, establish emergency access route, and enhance accurate treatment technologies are effective guarantee for saving lives, increasing cure rate and decreasing disability and death rate.
KEYWORDS: contrecoup severe brain injuries; high-repetitive surgeries; injury mechanism

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