颅脑外伤后进展性出血损伤的临床分析

Post-traumatic Progressive Hemorrhagic Injury In Clinical Analysis

目的:探讨颅脑外伤后进展性出血性损伤发病机制及早期诊断。方法:按血肿发生的部位、发生的时间、与GCS及原发颅脑损伤的关系、对收集本院脑外科63例颅脑外伤后进展性出血性损伤进行回顾分析..结果:63例颅脑外伤后进展性出血性损伤,其中硬膜外血肿12例,硬膜下血肿15例,脑内血肿29例,多发性血肿7例。发生时间多在伤后24 h内76%(48/63)。按入院时格拉斯哥昏分级(GCS)评分以9～12分为多57%(36/63);伤后低血压,缺氧,凝血障碍,术后颅压下降失去填塞效应、是进展性出血损伤发生的重要因素。结论:颅脑外伤首次CT有脑挫裂伤、蛛网膜下腔出血、颅骨骨折均有进展性出血性损伤发生的可能,GCS评分9～12分为多(57%)。大多发生在伤后24 h内,细致观察及颅内压监测,每4～6 h复查CT多能早期发现,提高治疗效果,降低病死率。

Objective：To investigate the mechanism and early diagnosis of progressive hemorrhagic lesions after brain injury. Methods：Sixty-three patients with post-traumatic progressive hemorrhagic lesions were retrospectively studied based on the site and time of onset related to GCS and primary brain injury. Results： The 63 cases of progressive hemorrhage after traumatic brain injury included 12 cases of epidural hematoma, 15 of subdural hematoma, 29 of intracerebral hematoma,and 7 of multiple hematomas which mostly occurred within 24h from the injury 76% （48/ 63）. Glasgow coma scores （GCS） at admission were 9 to 12 in 57% （36/63） of these patients. Post-traumatic hypotension, hypoxia, coagulation disorder, and lowered intracranial pressure after loss of tamponade effect, seemed to be important factors leading to progressive hemorrhage injury. Conclusion：Progressive hemorrhagic lesions may be likely to occur in those with cerebral contusion or laceration, subarachnoid hemorrhage~ and skull fractures as shown by primary brain CT. Such conditions may frequently measur 9 -12 in GCS, and mostly occurred within 24h after the injury. Careful inspection and monitoring of intracranial pressure as well as CT scanning repeated at 4 - 6 h intervals can be useful for early diagnosis, improved outcomes and reduction of fatality rate.