摘要
目的探讨如何正确选择手术指征不明确的急性外伤性颅内血肿的治疗方式与手术时机，提高对这类患者的救治率。方法搜集近3年内我科72例手术指征不明确的急性外伤性颅内血肿患者临床资料与预后情况，男48例，女24例；20～40岁者占74％。幕上血肿47例，幕下血肿25例。最终血肿量：幕上：30—40ml 18例，40～50ml 17例，〉50ml 12例；幕下：10～20m 110例，20～30ml 9例，〉30ml 6例。所有患者均在伤后24h内行首次CT扫描，入院后视病情变化随时复查CT。结果保守治疗31例，首次CT扫描无手术指征，后经动态观察有手术指征而手术41例；除院内死亡3例外，伤后6个月GOS评分显示恢复良好56例，轻残11例，重残2例。结论对于手术指征不明确的颅内血肿患者，应在病情演变过程中决定治疗方案，在病情观察中，既不能过分依赖于临床观察，也不能只注意头颅CT扫描结果，应综合考虑所获得的资料，选择对患者最有利的治疗方案。
Objective To study how to select therapeutic protocols and decide operation time for cases of acute traumatic intracranial hematoma without definite surgical indications so as to decrease mortality and morbidity. Methods Attention was paid to the clinical materials and prognosis of 72 cases of acute traumatic intracrainial hematoma without definite surgical indications in recent 3 years. There were 48 males and 24 females in the series, in which the cases at age range of 20-40 years accounted for 74%. Hematoma was located supratentorially in 47 cases and infratentorially in 25. The final hematoma volume was 30-40 ml in 18 cases, 40-50 ml in 17, 〉50 ml in 12 supratentorially, 10-20 ml in 10, 20- 30 ml in 9 and 〉 30 ml in 6 infratentorially. All cases underwent CT scan during the first 24 hours after injury and received follow-up CT scan according to the changes of patients＇ condition. Results Conservative treatment was performed in 31 cases. Surgical operation was done on another 41 cases after rigorous observation during hospitalization. Glasgow outcome scale 6 months after discharge suggested good recovery in 56 cases,mild disability in 11 and severe disability in 2. Three patients died of complex injury during hospitalization. Conclusion For cases of acute traumatic intracranial hematoma without definite surgical indications, the therapeutic protocols should be decided according to both the results of CT scan and clinical observation.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2007年第7期511-514,共4页
Chinese Journal of Trauma
关键词
脑损伤
体层摄影术
X线计算机
血肿
颅内
Brain injuries
Tomography, X-ray computed
Hematoma, intracranial
