颅内肿瘤切除术中急性脑膨出的原因及防治措施.DOCVIP

临床医学论文-颅内肿瘤切除术中急性脑膨出的原因及防治措施 ??? 作者;张建国，周 伟，栗超跃，柴 昌，步星耀 ［摘要］? 目的? 探讨颅内肿瘤手术中急性脑膨出的形成原因及防治措施。方法? 对颅内肿瘤切除术中出现急性脑膨出的13例患者资料进行回顾性分析，总结其形成原因及防治措施。结果? 肿瘤巨大，血供丰富，瘤周重度脑水肿，脑组织缺氧缺血，迟发性颅内血肿，体位不当，术中阻断回流静脉急性脑充血等，均为引起术中急性脑膨出的主要原因。正确摆放头位，大骨窗减压，梯度降低颅内压，过度通气，使用脱水剂，控制性降低收缩压等是防止术中脑膨出的有效措施。结论? 颅内肿瘤术中急性脑膨出由多种因素引起，针对病因采取积极适当的预防治疗措施，可以预防术中急性脑膨出的发生，减轻其发生后引起的脑组织损害，降低术后致残率和死亡率。??? ??? ［关键词］? 脑膨出；脑肿瘤；原因；防治??? Causes and treatment of acute intraoperative encephalocele in brain tumors??? ［Abstract］? Objective? To summarize the causes and preventive and treating methods of intraoperative acute encephalocele in brain tumors.Methods? 12 cases of brain tumor were analysed retrospectively，and the causes of encephalocele and preventive and treating methods were summarized.Results? Huge brain tumor and affluent angiogenesis，brain tissue anoxia and hypoxia，severe edema around tumor，delayed intracranial hematomas，inadequate posture and intraoperative cerebral venous obstruction causing acute hyperemia were the main causes of intraoperative encephalocele.Adequate posture，large decompressive craniotomy，decreasing intracranial pressure gradually，removing hematoma completely，large dose of mannitol for decreasing intracranial pressure，intraoperative hyperventilation，maintain of systolic blood pressure controlled and improvement of cerebral anoxia are effective methods for prevention and treatment of acute intraoperative encephalocele.Conclusion? Intraoperative acute encephalocele produce is caused by different factors.So it can be prevented and treated with corresponding measures to cut down the risk of acute brain encephalocele，and decrease the patients disability and mortality.??? ［Key words］? acute brain encephalocele；brain tumor；cause；prevention and treatment??? ??? 急性脑膨出是颅内肿瘤切除术中比较棘手的问题，临床上虽然比较少见，但如果术前准备不充分，不能及时诊断与处理，可造成严重后果，病死率、致残率很高。现回顾河南省人民医院神经外科近3年来颅内肿瘤切除术中急性脑膨出13例病人临床资料，分析术中急性脑膨出的形成原因，并结合文献对其防治措施进行讨论。??? ??? 1? 临床资料??? ??? 1.1? 一般资料? 本组13例，其中男7例，女6例。年龄19～56岁，平均42岁。额顶区巨大胶质瘤3例，颞顶枕区巨大胶质瘤2