课件：颅脑外伤基础知识和临床诊治要点广州中山医科大学讲解.ppt

脑损伤的观测 病情观察：意识、瞳孔、体征(神经系/生命)， （Cushing反应） 特殊监测：CT、颅内压、脑诱发电位。 ICP TCD Note book Neurosurgical ICU setup Sub-dural or parenchymal Ventricular 谢谢！ THANK YOU SUCCESS * * 可编辑 * Britains Princess Diana died early Sunday at a Paris hospital after suffering massive internal injuries in a high-speed car crash. She was 36. Her companion, Harrods heir Dodi Fayed, and their chauffeur died at the crash scene. Diana, Princess of Wales, died at 4 a.m. after going into cardiac arrest, doctors told a news conference at Paris Hospital de la Pitie Salpetriere. August 31, 1997 * 直接损伤：1 加速性损伤 着力伤coup injury 2 减速性损伤 对冲伤countrecoup injury 3 挤压性损伤 间接损伤：1作用臀部或足部脊柱传导颅底引起颅底骨折和脑损伤 2 作用躯干引起颅颈交界伤 挥鞭伤whiplash injury 3 胸部挤压静脉传递脑组织弥散点状出血称创伤性窒息traumatic apnea * CSF otorrhea may occur ass a result of a base of skull fracture involving the petrous temporal bone. Unlike fracture of the ant. Cranial fossa the leakage nearly always settles and the fistula does not usually provide a route of infection, unless there is evidence of chronic middle ear infection * CT scan showing ntracranial air in a subarachnoid space and within the lateral ventricles. * If a CT has not been performed: 1 it underlies the fracture (seen on the X ray) 2 it underlies a boggy swelling on the skull 3 it is on the same side as the pupil that dilated first 4 in 85% of cases it is on the contralateral sid to the hemiparesis Treatment “Cranioplasty for the Earthquake Survivor” 颅底骨折临床特点 前颅凹骨折:熊猫眼征/脑脊液鼻漏/嗅视神经损伤 中颅凹骨折:脑脊液鼻漏/耳漏/动静脉瘘/大出血/2~6神经损伤 后颅凹骨折:Battle征/后组颅神经损伤 Basal Skull Fractures 颅底骨折诊断治疗 诊断：临床表现 CT扫描 处理：注意有无合并脑损伤，注 意病情变化。 脑脊液漏的处理：持续半坐卧休息，抗生素。禁止漏口冲洗、堵塞。早期禁止腰穿，慎用脱水剂。 长期不愈合可行腰大池持续引流，必要时行颅底薄层CT和三维重建了解瘘口位置，手术治疗。 脑 外 伤 脑外伤的分类 根据脑组织与外界相通与否，分开放性和闭合性颅脑损伤。 闭合性颅脑损伤又可分为：①脑震荡；②脑挫裂伤；③脑弥漫轴索损伤；④脑干损伤；⑤丘脑下部的损伤。 闭合性脑损伤的机制 接触力 惯性力 对冲伤易发生在额极颞极及其底面 原发性或继发性脑损伤 原发性脑损伤：受伤当时出现症状和体征，无需手术，其预后取决于伤势。 继发性脑损伤：脑水肿、颅内血肿，伤后才出现症状和体征，常需开颅手术，其预后取决于伤势及治疗。 脑损伤的临床及诊断 意识障碍/头痛/恶心/呕吐 局灶症状与体征 颅内压增高症状与脑疝 生命体征变化 CT或MRI 正确规范的诊断名称书写 THANK YO