郑义亮　朱春雷　陈宇箴

[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岁15例,3～6岁43例,7～14岁94例;从受伤到入院的时间为20 min～6.20 h,平均 1.36 h。

1.2 致伤原因

本组患者中,交通意外伤85例,坠落伤36例,打击伤15例,跌伤7例,刺伤4例,其他原因受伤5例;闭合性颅脑损伤115例,开放性颅脑损伤37例;合并四肢骨折18例,血气胸12例,腹腔脏器损伤15例。

1.3 临床表现

本组患者入院时GCS均≤8分,其中,3～5分46例,6～8分106例;本组患者均存在不同程度的意识障碍,其中,轻度昏迷104例,中到重度昏迷48例;瞳孔改变81例,其中,一侧瞳孔散大49例,双侧散大22例,大小多变10例;其他表现:呕吐119例,癫痫28例,偏瘫21例,颅神经损伤15例,锥体束征阳性57例,去大脑强直20例;生命体征变化:呼吸功能障碍46例,其中呼吸停止6例,心动过速32例,心动过缓41例,低血压30例,休克12例。