急性颅内血肿清除术后迟发性血肿的临床分析

A Clinical analysis of the delayed traumatic intracranial hematoma after the evacuation of acute intracranial hematoma

目的探讨急性颅内血肿清除术后,如何及时发现颅内迟发性血肿并及时治疗、提高疗效。方法对29例颅内血肿清除术后并发迟发性血肿的病例进行临床分析。结果再次手术清除颅内血肿25例,其中恢复良好12例,中残6例,重残4例,植物生存2例,死亡5例。结论手术后颅内血肿的发生有多种机理。在清除急性外伤性颅内血肿时发生急性脑肿胀或术后病情恶化应想到对侧迟发性颅内血肿可能,尤其首次CT提示颅内血肿伴脑挫裂伤或小出血灶的病例,宜动态复查CT,早诊早治以改善预后。

Objective To improve the curative effect of delayed traumatic intracranial hematoma byearly diagnosis and treatment after the evacuation of acute hematoma. Methods 29 cases of delayedtraumatic intracranial hematoma were analyzed retrospectively. Results 25 cases underwent the re-evacuation of the delayed hematoma. 12 cases with good outcome, 6 cases with mild disability, 4 casessevere disability, vegetative state 2 cases and 5 died. Conclusions The mechanism of delayed traumaticintracranial hematoma is versatile. The occurrence of delayed traumatic intracranial hematoma wasprobable if the unexplainable acute brain swelling was present during the acute hematoma were beingevacuated or the state of patients deteriorated post operative, esp. the first CT scanning indicatedintracranial hematoma with brain laceration or small amount of bleeding. The dynamic CT scanning post-operatively was suggested to early diagnosis and treatment.