探讨重型颅脑损伤术中急性脑膨出的原因及处理措施。

回顾分析扬州大学附属医院神经外科自2012年9月至2015年12月收治的58例重型颅脑损伤患者术中发生急性脑膨出的临床资料；其中男性41例，女性17例，年龄3~72岁；58例患者均行手术治疗，术中均发生急性脑膨出，复查CT后因迟发性血肿继续手术37例。

58例患者存活42例（72.4%），死亡16例（27.6%）；存活患者随访3个月~3年，按GOS评分，5级恢复良好19例（32.8%）；4级轻度残疾8例（13.8%）；3级中重度残疾11例（19.0%）；2级迁延性昏迷4例（6.9%）。

迟发性颅内血肿是重型颅脑损伤开颅术中发生急性脑膨出的主要原因，术前充分评估、术中及时的CT复查以及术者永不放弃的坚强信念，三者紧密结合，可以有效提高救治成功率，降低病死率。

To analyze the causes of acute intra-operative encephalocele and the treatment for severe craniocerebral injury.

The clinical data were collected and analyzed for 58 patients with severe head injuries who suffered acute intra-operative encephalocele and collected in our hospital from September 2015 to December 2015. There were 41 males and 17 females with an age range of 3 to 72 years old. All the 58 patients underwent surgical treatment. Acute encephalocele occurred in all patients, and 37 cases of delayed hematoma after CT were reoperated.

Among these 58 patients, 42 cases survived (72.4%), 16 cases died (27.6%); the surviving patients were followed up for 3 months~3 years, according to the GOS score, 19 patients reach favorable recovery (32.8%) (5 degree), 8 cases with moderate disabled (13.8%) (4 degree), 11 cases with severe disabled (19.0%) (3 degree), 4 cases inpersistentcoma (6.9%) (2 degree).

The main cause of acute encephalocele during the operation of severe craniocerebral injury was delayed intracranial haematoma. Sufficient preoperative assessment, a timely review of CT in operation and the never give up of strong faith, together, can effectively improve the treatment success rate, and the mortality can be reduced.