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目的探讨颅脑损伤患者开颅术后再出血原因及防治措施。方法回顾性分析医院2006年1月-2011年12月所行618例颅脑损伤患者开颅术后发生再岀血35例患者的临床资料。结果急性硬膜下血肿及其伴脑挫裂伤患者术后发生再出血机率明显高于单纯硬膜外血肿及脑挫裂伤伴颅内血肿患者(P<0.01),凝血功能异常颅脑损伤患者术后再岀血发生率明显高于凝血功能正常颅脑损伤患者(P<0.01)。而患者预后与病情危重程度(GCS评分)及发现再出血早迟有关,本组35例患者中,再手术32例,保守治疗2例,放弃治疗1例,死亡5例。结论急性硬膜下血肿伴脑挫裂伤及凝血功能障碍等因素为术后再出血基础因素,而术中止血不可靠为术后发生再出血直接原因。术中彻底可靠止血.动作轻柔仔细操作及维持患者生命体征平稳等防范措施是预防术后再出血的关键所在,及早发现和手术可最大限度挽救患者生命。
Objective To explore the causes and preventive measures of rebleeding after craniotomy in patients with craniocerebral injury. Methods A retrospective analysis was performed on the clinical data of 35 patients with rebleeding after craniotomy in 618 patients with traumatic brain injury in the hospital from January 2006 to December 2011. Results The incidence of rebleeding after acute subdural hematoma and cerebral contusion in patients with traumatic brain injury was significantly higher than that of simple epidural hematoma and cerebral contusion with intracranial hematoma (P <0.01), coagulation abnormal craniocerebral injury The incidence of rebleeding after operation was significantly higher in patients with normal craniocerebral injury (P <0.01). The prognosis of patients with the severity of the disease (GCS score) and the discovery of early or late rebleeding, 35 patients in this group, 32 cases of reoperation, conservative treatment in 2 cases, give up treatment in 1 case, 5 cases of death. Conclusion Acute subdural hematoma with cerebral contusion and coagulation dysfunction and other factors for postoperative basic bleeding rebleeding, and intraoperative hemorrhage unreliable as the direct cause of postoperative rebleeding. Complete and reliable intraoperative hemostasis. Gentle and careful action and maintenance of patient vital signs and other preventive measures to prevent postoperative bleeding is the key, early detection and surgery can maximize the patient’s life-saving.