2026年 · 第106卷第29期

On the evening of May 8, 2026, the mother of the patient Xiao L sent me the video of Xiao L walking and exercising independently in the rehabilitation hospital, and thanked me for my assistance. I was as moved as this mother: this 22-year-old girl who was unfortunately involved in a major car accident suffered from bifrontal brain contusion and laceration, and severe fractures of skull base and craniorbital surface. Although she underwent bifrontal decompressive craniectomy, she experienced a series of secondary central and peripheral key organ injuries such as severe ischemic cerebral edema, hypothalamic injury, secondary neurogenic pulmonary edema, liver dysfunction and severe water and electrolyte disorder less than 3 days after the operation. I was contacted by a peer to assess whether the young patient had a silver lining of survival. According to the limited information of imaging data and laboratory examinations provided by local doctors, I can only judge that patients with such critical illness should be referred to the neurosurgical critical care platform with higher diagnosis and treatment level and better equipment and facilities for treatment. However, when I suggested that she be transferred to Xuanwu Hospital for treatment, the local doctor in charge considered the patient's safety, worried about the risk of death during the transfer, and tried her best to prevent the long-distance transfer of patients. However, we believe that if local doctors believe that the patient has no hope and continues to stay in the local area for treatment, the patient's hope of recovery will be even slimmer. We explained the pros and cons to the family members in detail on the phone, and the family members finally made up their minds to take the risk of transporting the patient. After being transferred to our department, after active treatment, it took only 5 days for the patient's consciousness to basically recover; After 2 weeks of treatment such as adjusting liver function and correcting electrolyte disorder, I suggested that she should be transferred to a well-known specialist hospital for optic canal decompression to save her vision in combination with the serious damage of her vision in both eyes. However, after seeing her condition, the receiving doctor made a judgment that although the patient's consciousness had recovered, the systemic complications were serious, and it was of little significance to save her vision. Hearing the news, the patient's family nearly collapsed. But based on the patient's clinical manifestations and consciousness, we judged that she should have a good outcome, and encouraged the mother to undergo this vision-saving operation, and the results confirmed our judgment.