颅脑损伤颅内多发血肿的治疗

Treatment for bilateral multiple intracranial hematomas in head injury

目的 总结颅脑损伤颅内多发血肿的治疗经验,提高此类患者的疗效。方法 回顾我科近10年4 2 5例颅脑伤后颅内双侧多发血肿的临床资料。按照主要血肿的分布,将病员分为硬膜外血肿组(EDH)、硬膜下血肿脑挫裂伤组(SDH+BCL)和脑挫裂伤脑内血肿组(BCL +ICH)。对于不同类型血肿在合适的时机采取合适的手术方法,及时实行ICP监测,不行双侧大块脑组织切除,术中或术后立即复查头颅CT。结果 12 1例未经手术治疗,其中死亡4例(3.3% ) ;手术30 4例,死亡17例(5 .6 % )。EDH组12 7例,全经手术治疗,无死亡;SDH+BCL组14 3例,手术116例,11例死亡(7.7% ) ;ICH组15 5例,手术6 1例,10例死亡(6 .4 % )。结论 颅脑损伤颅内双侧多发血肿应采取综合治疗,选择合适的手术时机和方法治疗可提高治愈率,改善预后。

Objective To study and summarize the therapeutic experiences about bilateral multiple intracranial hematomas in head injury in order to improve the curative effect on this kind of patients.Methods The clinical data of 425 cases with post-traumatic bilateral multiple intracranial hematomas were retrospected. According to hematoma's position, the patients were classified to three groups: the first with extradural hematoma (EDH), the second with a combination of homolateral subdural hematoma and brain contusion-laceration (SDH+BCL), the third with a combination of BCL and intracerebral hematoma (BCL+ICH). Appropriate operative manner in timely occasion were taken in allusion to types of these hematomas. Immediate intraoperative and postoperative computed tomography (CT) scan proved to be mandatory. Timely intracranial pressue (ICP) monitoring was carried out. Results 121 patients were treated conservatively, 4 of whom died (3.3%). 304 patients underwent one or more surgeries, 17 died ( 5.6% ). Conclusions The integrated therapeutic manner with appropriate operative manners in timely occasions can boost curative rate and ameliorate prognosis.