外伤性急性硬膜下血肿选择性非手术治疗体会

Criteria conservative treatment for acute subdural haematomas

目的探讨急性硬膜下血肿选择性非手术治疗的适应证。方法回顾性分析近5年来保守治疗74例外伤性急性硬膜下血肿患者的临床资料。所有患者入院后即行持续颅内压监护,并根据颅内压的变化随时调整治疗方案。结果 62例保守治疗,6例急诊开颅清除血肿,4例亚急性期血肿钻孔冲洗引流,2例慢性硬膜下血肿钻孔引流。结论除急诊手术外,部分急性硬膜下血肿患者在严密监护下,尤其在持续颅内压监护下,保守治疗或延期手术取得良好的效果。

Objective To investigate the criteria conservative treatment for acute subdural haematomas（ASDH）. Methods 74 patients with ASDH had been treated conservatively during the past 5 years were analyzed retrospectively. Results Through the continual intraeranial pressure （ICP） monitoring of all the patients after admission, the treatment was adjusted according to the change of ICP. 62 patients got good recovey by conservative treatment. 6 patients had the haematoma evacuated later because of adeterioration of the condition. 4 cases were operated by boring drainage due to subacute subdural haematomas. 2 cases developed into chronic subdural haematomas （CSDH） and also were operated. There was no mortality and all patients got good recovey. Conclusions Except emergence operation, some cases achieved better prognosis under closed wardship,especically the continual intracranial pressure monitoring. Patients with a midline shift of less than 10mm,GCS≥ 13, ICP 〈 2.67kPa, and open of basal cisterns as well as can be treated conservatively which benefits on directing and adjusting treatment properly, reduces the complications and improves the prognosis.