特急性颅内血肿手术时机的选择

Analysis of treatment of peracute intracranial hematoma

目的总结特急性颅内血肿的发展规律、临床特点及诊治经验，选择正确的手术时机。方法回顾性分析笔者所在科近6年121例特急性颅内血肿患者的临床资料。通过对其临床表现、影像学特征的分析研究，找出特急性颅内血肿的发展规律，发现最佳手术时机。结果根据COS评分判断预后，非手术治疗43例，恢复良好21例（48．8％），中残7例（16．3％），重残3例（7．0％），植物生存4例（9．3％），死亡8例（18．6％）。手术治疗78例：恢复良好38例（48．7％），中残10例（12．8％），重残9例（11．5％），植物生存9例（t1．5％），死亡12例（15．4％）。结论对入院有误吸、低血压、缺氧情况存在及颅内多发血肿早期尽量保守治疗，改善供氧，动态CT观察，选择好手术时机可避免或减少脑膨出发生。对迟发血肿导致脑膨出，根据头颅CT和临床表现分析脑膨出原因，采取正确方案。

Objective To summarize developmental tendency, clinical characteristics and therapeutical experience of peraeute intracranial hematoma and to choose correctly operative or non - operative method. Methods To retrospecively analyze the clinical data of 12t cases for peraeute intracranial hematoma for about 6 years. Summarizing on clinical characteristics and iconogTaphic manifestation, we found developmental tendency, optimal therapeutic time and method. Results According to GOS score, in non -operative 43 cases, 21 cases（48. 8% ） were survived in good condition, 7 cases（ 16. 3% ） had moderate disability, 3 eases（7.0% ） had severe deficit, 4 cases（9.3% ） were vegetative and 8 cases（ 18.6% ） were dead. In operative 78 cases, 38 cases（48.7% ） in good condition, 10 cases（ 12.8% ） had moderate disability, 9 cases（ 11.5% ） had severe deficit, 9 cases（ 11.5% ） were vegetative and 12 cases （ 15.4% ） were dead. Conclusion Non - operative method and dynamically CT scan could be selected temporary for cases accompanied with inhalation pneumonia, anoxia and intracrani- al muhihematomas. Motality may be reduced by emergent holing hematoma evacuation, craniotomy with large bone - flap, and tentorium cerebeUi hiatus incision. The acute intraoperative encephalocele in traumatic head iujured patients could be prevented and treated according to different causes by early discovery, preperatoin.