急性硬膜下血肿189例手术分析

ACUTE SUBDURAL HEMATOMA-AN ANALYSIS OF 189 CASES

为探讨严重脑外伤急性硬膜下血肿（ＳＤＨ）及时手术的预后影响因素，回顾性分析了近十年经手术治疗的１８９例急性硬膜下血种。结果：预后良好８３例（４３９％），重残１３例（６９％），植物生存７例（３７％），死亡８６例（４５５％），对预后有影响的因素有：ＧＣＳ、瞳孔反应、低血压或／和低氧血症、合并脑肿胀、双侧硬膜下血肿及年龄超过６０岁者。表明原发性脑损伤程度和继发性缺血缺氧、脑水肿、脑肿胀、颅高压是影响急性硬膜下血肿预后的关键，及时清除血肿可减缓继发性脑损害，因而对预后有显著的潜在影响。

Objective:To investigate the factors influencing the operation outcome of severely head injury with acute subdural hematoma (SDH).Methods:189 operated cases of acute subdural hematoma were retrospectively collected and analyzed.Results:The overall mortality was 45.5%,and the functional recovery rate was 43.9%. The following factors statistically correlated with the outcome( P <0.05): pre-operation GCS,pupils reaction,hypotension and/or hypoxia,brain swelling,bi-SDH,age over 60 years. Moreover,the GCS and pupil reaction.were the best parameters prodicting the outcome.Conclusion:In acute SDH,the extent of primary brain injury and the secondary brain swelling,brain edema and intracranial hypertension are more important than the subdural clot itself in affecting the outcome.Rapid removal of the hematoma may play an important role on preventing the development of the secondary pathophysiological process,but the effect is restricted by the extent of brain damage.