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颅脑火器伤的急救措施 |
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章 翔 费 舟 易声禹 傅洛安 张志文 张剑宁
顾建文 刘卫平 宋少军 王占祥 贺蛲生 扬利孙
【摘要】 目的 探讨颅脑火器伤患者的治疗效果。方法 前瞻与回顾性分析我院27年间诊断为颅脑火器伤的93例患者。全组均系急性颅脑火器伤，其中男81例（87.1%），女12例（12.9%）；年龄3个月～58岁（平均24.6岁）。损伤类型为颅脑穿透伤，包括：切线伤16例，盲管伤58例和贯通伤19例。损伤特点是：伤情急、创伤重、病情变化快。本组病例均行手术治疗及加强神经外科监护（包括复苏）等围手术期处理。结果 经急救和手术处理后，9例死亡（9.7%）。于3个月时随访研究发现，56例恢复良好（66.7%）；中残、重残及植物生存率分别为19.0%,10.7%和3.6%。长期随访研究（平均5.5年）表明，42例（50.0%）恢复了工作能力。 结论 颅脑火器伤者伤情多较危重，需行紧急救治。在创伤早期采取及时、适度和彻底的清创术，是避免神经系统功能迅速恶化的重要措施。
【关键词】 头部损伤 创伤，枪击 急救
First-aid Measures for Craniocerebral Firearm Wounds
ZHANG Xiang, FEI Zhou, YI Shengyu, et al.
Dept. of Neurosurgery, Xi-Jing Hospital, Fourth Military Medical University,
Xi'an 710032
【Abstract】 Objective To review the outcome of treatment in patients with craniocerebral firearm wound. Methods We prospectively and retrospectively reviewed a series of 93 patients who presented to our hospital with a diagnosis of firearm wound to the head during a 28 year period. Of these, 81 were males (87.1%) and 12 females (12.9%) with the age ranging from 3 months to 58 years (median 24.6 years). The lesion type was penetrating craniocerebral injuries, in which 16 were tangential wounds, 58 tubular wounds and 19 through-and -through wounds. All patients underwent surgical intervention and resuscitative protocols in the neurosurgical intensive care unit. Results After emergency treatment and operation, 9 cases died (9.7%). Follow-up studies of three months showed that 56 cases (66.7%) had made a good recovery. Moderate disability, severe disability and vegetative state in this series were 19.0%, 10.7% and 3.6%, respectively. Long term follow-up studies (median 5.5 years) indicated that 42 cases(50.0%) were able to resume their occupation. Conclusions Craniocerebral firearm wounds are often severe, needing urgent treatment. Timely, adequate and complete initial debridement is crucial to avoid rapid neurological deterioration.
【Key words】 H[1] [2] 下一页
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