小儿重型颅脑损伤治疗体会.docVIP

小儿重型颅脑损伤治疗体会 　　[摘要] 目的:总结小儿重型颅脑损伤的救治经验。方法:对我院2002年1月～2008年12月收治的小儿重型颅脑损伤患者152例的临床资料进行回顾性分析。结果:152例患者,手术治疗105例,非手术治疗47例,随访1年,132例存活。92例患者恢复良好,轻残17例,中残13例,重残10例,死亡20例,病死率为13.16%。结论:院前急救、早期诊断、早期手术和有效的综合治疗能明显改善小儿重型颅脑损伤的预后;小儿重型颅脑损伤应积极救治,以获得良好预后。 　　[关键词] 小儿;重型颅脑损伤;治疗 　　[中图分类号] R72 [文献标识码]B[文章编号]1673-7210(2009)08(c)-161-02 　　 　　The treatment of severe brain injury experience for children 　　ZHENG Yiliang, ZHU Chunlei, CHEN Yuzhen 　　(Department of Neurosurgery, the Changping Hospital of Dongguan City, Dongguan 523573, China) 　　[Abstract] Objective: To evaluate the children for treatment of severe brain injury experience. Methods: From January 2002 to December 2008 admitted to the pediatric patients with severe head injury clinical data of 152 cases were retrospectively analyzed. Results: 152 cases of patients, surgical treatment of 105 cases, 47 cases of non-surgical treatment, follow-up of 1 year, survival of 132 cases. 92 cases of patients with good recovery, 17 cases of residual light, in 13 cases of disabled, severely disabled 10 cases, 20 cases of death, the mortality rate was 13.16%. Conclusion: The pre-hospital emergency treatment, early diagnosis, early and effective operation of the comprehensive treatment in children can significantly improve the prognosis of severe head injury. Severe head injury in children should be actively treated in order to obtain a good prognosis. 　　[Key words] Children; Severe brain injury; Treatment 　　 　　小儿重型颅脑损伤是指年龄≤14岁、GCS(格拉斯哥评分)≤8分、伤后昏迷或再昏迷时间6 h的颅脑损伤患者[1]。小儿重型颅脑损伤是神经外科常见的疾病类型,致死致残率极高,总结小儿重型颅脑损伤的救治经验,对提高诊治水平有非常重要的意义。我院2002年1月～2008年12月共收治重型颅脑损伤患儿152例,现报道如下: 　　1 资料与方法 　　1.1一般资料 　　本组152例小儿重型颅脑损伤患者中,男性95例,女性57例;年龄7个月～14岁,平均(8.15±2.26)岁,其中, 　　3.3 低血压和低???血症的防治 　　重型颅脑损伤的患者常伴有低血压和低氧血症,低氧血症和低血压是导致脑组织继发性脑损害的重要因素,病死率高,有文献报道[3]重型颅脑损伤的患者并急性呼吸功能障碍的发生率为50%～85%,应当高度重视低血压的防治:①早期扩容;②控制活动性出血;③合理使用利尿剂;④减少术中出血。此外,呼吸中枢的直接、间接损伤、误吸、广泛微小肺不张、神经源性肺水肿以及肺部感染等,常常为几种原因同时存在,共同的结局是导致低氧血症。因此,在救治过程中应保持呼吸道通畅,给氧,有呼吸道梗阻或分泌物较多时,及早气管插管或切开,如有呼吸频率和幅度