颅脑外伤后进展性出血损伤46例诊治分析

Diagnosis and treatment of progressive hemorrhage injury following craniocerebral trauma:a report of 46 cases

目的:探讨颅脑外伤后进展性出血损伤(PHI)的临床诊断和治疗。方法:根据46例PHI患者入院时格拉斯哥昏迷评分(GCS)、伤后距首次CT检查时间、血肿类型与PHI发生的关系,PHI部位分布情况及治疗、预后等因素分析PHI的临床特点。结果:颅脑原发损伤越重,伤后首次CT抢救时间越早,PHI的发生率越高;PHI类型中,颅内血肿25例,硬膜外血肿11例,硬膜下血肿7例,蛛网膜下腔出血3例;痊愈和恢复良好20例,轻残12例,重残8例,病死6例。结论:对于中重型颅脑外伤患者,尤其伤后2 h以内首次CT检查者,要在之后的6 h内行CT复查,以便及时发现PHI,早期诊断,早期治疗,有利于提高患者治愈率和生活质量,降低病死率和致残率。

Objective：To explore the clinical diagnosis and treatment of progressive hemorrhage injury（PHI） due to craniocerebral trauma.Methods：The clinical data of 46 patients with PHI were analyzed retrospectively,and the clinical features were discussed according to the Glasgow coma score at admission,first CT time after injury,hematoma type and PHI distribution.Results：The PHI was most often detected in patients with severe primary brain injury or receiving early CT rescue after injury;among the 46 PHI cases,25 had intracerebral hematoma,11 epidural hematoma,7 subdural hematoma and 3 subarachnoid hemorrhages.Satisfactory results were observed in 20 cases,slight disability in 12,sever disability in 8 and mortality in 6.Conclusions：Patients with severe traumatic brain injury,especially those receiving CT examination within 2 hours after injury should be rechecked within 6 hours to detect PHI.Early diagnosis and treatment may help to improve the patients′ cure rate and reduce the mortality and rate of disability.