重型颅脑损伤后脑疝伴休克的救治策略

Treatment strategies for brain hernia combined with hemorrhagic shock following severe traumatic brain injury

摘要:

目的：探讨重型颅脑损伤（severe traumatic brain injury，sTBI）后脑疝伴休克的早期救治策略及其对预后的影响。方法：回顾性分析我院2009年8月至2011年4月按照一体化急救创伤救治模式治疗的32例脑疝伴失血性休克患者（观察组），并与同期收治的常规治疗方法救治的22例同类患者（对照组）进行比较，患者1周内死亡率以及伤后半年的格拉斯哥预后评分（glasgow outcome score，GOS）。结果：2周后观察组患者死亡率为34.4%（11/32），对照组患者死亡率为45.5%（10/22），二者差异无统计学意义（P ＞0.05）；与对照组比较，观察组患者损伤后6个月GOS伤残评级Ⅰ、Ⅱ级所占比例明显提高，Ⅲ、Ⅴ级所占比例降低，二者差异有统计学意义（ ?字2=4.909，P=0.027）。结论：在一体化急救创伤救治模式的基础上，按休克程度行选择性早期颅脑手术可以提高sTBI后脑疝伴失血性休克患者的早期救治效果，改善患者的预后。

Abstract:

Objective：To explore emergency treatment strategies for patients with brain hernia combined with hemorrhagic shock after severe traumatic brain injury and to discuss their effects on prognosis． Methods：A retrospective analysis was made on 32 patients（ob－servation group） with brain hernia combined with hemorrhagic shock treated by selective strategies on the basis of integrative strate－gies from September 2009 to April 2011；another 22 patients（control group） with the same injuries were treated by routine strategies. Mortality within one week and glasgow outcome score（GOS） at six months after injury were compared between two groups. Results：Mortality rate was 34.4%（11/32） in observation group and 45.5%（10/22） in control group two weeks later（P >0.05）. GOS disability rating（Ⅰ，Ⅱ level） were higher in observation group than in control group at six months after injury；GOS disability rating（Ⅲ，Ⅴ level） were lower in observation group than in control group at six months after injury（ ?字2=4.909，P=0.027）. Conclusions：Early se－lective strategies based on degree of shock combined with integrative strategies may obtain better outcome for patients with brain her－nia combined with hemorrhagic shock after severe brain injury.