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用改良双额颞大骨瓣减压术治疗外伤性急性弥漫性脑肿胀
颅脑外伤后急性弥漫性脑肿胀(posttraumaticacute diffuse brain swelling,PADBS),常发生于重型颅脑损伤病例,是导致颅脑损伤患者死亡的常见重要原因.目前,针对本病的治疗和手术方法并不统一,为此,笔者近年来采用双额颞大骨瓣减压术治疗PADBS,试图为解决这一临床难题提供一种较为可行的方法.经实践证明该求式的效果较满意,现总结报道如下.
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大脑半球减压术治疗急性弥漫性脑肿胀
外伤性急性弥漫性脑肿胀(posttraumatic acute diffuse brain swelling,PADBS)是指伤后数小时(一般4~14 h)脑组织广泛肿大 或膨胀.临床上较常见,死亡率极高.我院自1996年1月至2001年12月共收治外伤性急性弥漫性脑肿胀患者32例,其中12例行大脑半球减压术,现报告如下.
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外伤后急性弥漫性脑肿胀
外伤后急性弥漫性脑肿胀(Posttraumatic acute diffuse brain swelling PADBS),临床上较为常见,它可以单独存在或与各种类型颅脑损伤同时存在,是影响脑外预后的生要因素.近年来随着CT的广泛应用,其诊断已不困难,发生率逐渐增加.
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外伤性急性弥漫性脑肿胀的诊治
外伤性急性弥漫性脑肿胀(posttraumatic acute diffuse brain swelling,PADBS)是指外伤后数小时脑组织广泛肿大或肿胀,大部分合并急性硬膜下出血或硬膜外血肿或脑挫伤,部分则单独存在,临床较为常见.我科自1996年8月~2001年2月,共收治外伤性急性弥漫性脑肿胀68例,报道如下.
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26例外伤后急性弥漫性脑肿胀术中急性脑膨出的防治体会
外伤后急性弥漫性脑肿胀(Posttraumatic acute diffuse brain swelling PADBS)属特重型颅脑损伤,是外伤后脑组织严重损伤的表现,死亡率高,预后差.近年专家建议PADBS手术指征尽量放宽,可挽救大部分患者生命,且可改善预后,提高生存质量[1].但术中发生急性脑膨出率高达45.4%[2],一旦出现后死亡率几乎是100%,因此怎样防治急性脑膨出的发生是提高治愈率的关键.我科自1999年1月以来,收PADBS患者26例,皆行手术治疗.术前、术中采用亚低温,控制血压及呼吸等综合防治法,使脑膨出发生率降至15.4%.现将该组资料报告如下.
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外伤性急性脑肿胀的诊疗研究
脑肿胀(Brain swelling ortumefaction)初用于病理学,它是指脑体积增大的形态改变.但病理学中用"脑水肿"指体积增大而湿润的脑组织,而用"脑肿胀"表示体积增大而较的脑组织.前者主要为细胞外水肿,后者主要为细胞内水肿[1].外伤后急性弥漫性脑肿胀(Post-automatic Acute Diffuse Brain Swelling.PADBS)是指外伤后数小时内(一般4~14小时)脑组织广泛肿大或膨胀[2].临床上较为常见.它可以单独存在或与各种类型颅脑损伤同时存在,是重型颅脑损伤死亡率高的重要原因之一.近年来随着CT广泛应用,该病诊断已不困难,对其发病机理和治疗也有进一步认识.
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Objective: To assess the relationship between the prognosis of the patients with diffuse traumatic brain swelling (DTBS) and the changes of the ventricles and the cisterns in CT scans.Methods: The outcome of the patients with DTBS and the changes of the ventricles and the cisterns in CT scans were studied and analyzed in a group of 268 cases.We focused on the changes of the third ventricle and the basal cistern, age and Glasgow Coma Scale (GCS).Results: Of 268 cases, there were changes of the third ventricle and/or the basal cistern in 124, 65 died. In 18 cases, the third ventricle and the basal cistern were both absent and 16 died (88.9%). The third ventricle changed significantly in 59 cases, 33 died (55.9%), while the basal cistern changed in 47 cases and 16 died (34%). Of the 124 patients with changes of the third ventricle and/or the basal cistern, 26 were children, 8 died; 98 adults, 57 died.Conclusions: For patients with DTBS, the outcome was in direct correlation with the change of the third ventricle and/or the basal cistern, the change of the third ventricle was much more important in assessment of the outcome than that of basal cisterns. There is no significant difference in, the incidence of DTBS between children and adults while the outcome of children is much better than that of adults. The patients with the changes of the third ventricle and the basal cistern accompanied with lower GCS scores have poor outcome.