特发性颅脑损伤后迟发性脑肿胀28例临床分析

摘要

目的：探讨特发性颅脑损伤后迟发性脑肿胀的发病特点及预防治疗。方法回顾性分析我院2006年8月至2013年8个月收治的28例迟发性颅脑损伤后脑肿胀患者的临床资料。结果本组28例经过6～12个月随访，依据GOS分级标准：恢复良好26例（92．9％），死亡2例，病死率7．1％。结论迟发性脑肿胀好发于对冲性额、颞叶挫裂伤伴明显蛛网膜下腔出血、硬膜下广泛薄层血肿及早期CT有轻度脑肿胀者，其发病机制可能与创伤后的迟发性脑血管痉挛、微循环障碍、静脉回流障碍及甘露醇作用下降等因素有关。迟发型脑肿胀发病隐匿，突然，多在病情好转后7～10 d突然加剧，死亡率较高。早期有效干预及预防是减少并发症、降低死亡率和致残率的关键。%Objective The features of onset and preventive treatment of idiopathic delayed brain swelling after head injury are investigated.Methods Clinical data of 28 cases of idiopathic delayed brain swelling after head injury admitted to our hospital from August 2006 to August 2013 were analyzed retrospectively.Results All the patients were followed up for 6~12 months.According to GOS grading, there were 26 cases of good recovery (92.9%) and 2 dead cases with the mortality of 7.1%.Conclusion Delayed brain swelling usually occurs in frontal and temporal lobe contusion with subarachnoid hemorrhage, subdural thin layer of hematoma and early CT with mild brain swelling. The pathogenesis may be related to the delayed cerebral vasospasm post-trauma, the microcirculation disturbance, the disturbance of venous flowing, the decline of mannitol function and the other factors.Because of the insidious and sudden onset of the disease and sudden worsening after improvement for 7 ~10 d, the mortality is very high. Therefore, the early effective intervention and the prevention are the keys to reduce the complications, mortality and morbidity.