外伤性颅内血肿20-30mL的治疗对策

Operative and Non-operative Treatment on the 20～30ml Traumatic Intracranial Hematoma

【目的】对比外伤性颅内血肿20-30 mL保守治疗和手术治疗的预后。【方法】对本院1997年7月至2002年7月符合条件的47例外伤性颅内血肿进行保守治疗,对2002年8月至2006年3月的33例患者进行手术清除血肿,比较两组患者的预后和并发症。【结果】保守治疗组住院时间平均（26.6±13.1）d,出院时复查头部CT血肿都吸收,28例得到随访,有11例后遗有经常性的头痛头昏症状,双侧视力明显下降7例,5例偏瘫。GOS预后：死亡1例,重残1例,中残8例,良好18例。手术治疗组平均住院时间（16.8±15.3）d,与第一组比较差异有显著性（P〈0.05）。随访30例,有5例诉有经常性头痛头昏,双侧视力下降2例,偏瘫5例（运动性）。GOS预后：死亡1例,死于手术后双侧颈内动脉梗塞,中残3例,良好26例。【结论】外伤性颅内血肿20-30 mL的患者手术治疗能显著缩短平均住院日,降低头痛和视力下降的并发症。

[Objective] To investigate the prognosis of operative and non-operative treatment on the 20ml -30ml traumatic intracranial hematoma. [Methods] Forty seven cases of 20ml- 30ml traumatic intracranial hematoma within from July 1997 to 2002 were treated by non-operative methods, and 33 cases of similar hematoma from August 2002 to March 2006 were treated by hematoma evacuation . Prognosis and traumatic syndromes were compared between two groups. [Results] The average period of non-operative patients in hospital were 26.6± 13.1 days. Hematomas were absorbed when the patients discharged in CT images. Twenty eight cases had been followed up, 11 of which had frequent headache and daze, 7 of which had obvious dim-sight and 5 of which existed hemiplegia. The scores of prognosis by GOS after 6 months were as follows： one case was dead（D）, one case was severely disabled（SD）, 8 cases were moderately disabled（MD） and 18 cases were good recovery（G）. The average period of the operative patients in hospital were 16.8±15.3 days as compared with that of the above group（ P 〈0.05）. Thirty cases had been followed up, 5 of which had frequent headache and daze, 2 of which had obvious dim-sight and 5 of which existed hemiplegia. GOS after 6 months were as follows： D was one case, 3 cases was MD and 26 cases was G. [Conclusion]The operative treatment on 20-30 mL traumatic intracranial hematoma can obviously shorten average hospital days, reduce headache, daze and dim-sight as compared with those by non-operative treatment.