目的 观察开颅血肿清除术治疗重型脑干出血的临床效果.方法 重型脑干出血患者12例,格拉斯哥昏迷评分(GCS)3～4分,均采用开颅血肿清除术.术后12 h内复查颅脑CT;术后6个月时,进行格拉斯哥预后量表(GOS)评分.结果 颅脑CT显示,8例血肿接近完全清除(>95％)、4例大部分清除(85％～95％).术后6个月,GOS评分1分5例、2分2例、3分4例、4分1例,其中血肿量≥10 mL者均死亡.结论 开颅血肿清除术治疗重型脑干出血患者临床效果好,但对于血肿量≥10 mL者无效.

Objective:To observe the clinical effect of bevacizumab in the treatment of refractory brain edema.Methods:Eight patients with refractory brain edema who were treated with regular dehydration and hormone for one week in the neurosurgical intensive care unit of Neurosurgery Department of Nanjin Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from July 2020 to June 2021 were selected as the research objects. All patients were given bevacizumab 200 mg, diluted to 0.8 mg/mL with 250 mL normal saline under sterile technology, and continued intravenous drip for more than 90 min. The amount of brain edema and the improvement of GCS score were compared before and after treatment.Results:For patients with refractory brain edema, bevacizumab could significantly improve brain edema. Imaging examination showed that brain edema was improved 2 d after treatment. The amount of brain edema measured 1 week after treatment of all patients were relieved compared with that before treatment, and the GCS score of all patients were higher than that before treatment.Conclusion:Bevacizumab is effective in the treatment of neurosurgical refractory brain edema, which can reduce brain edema and improve the clinical prognosis.