开颅手术后并发迟发性颅内血肿的观察与治疗

Observation and treatment of delayed intracranial hematoma after craniotomy

目的:探讨迟发性颅内血肿(DTIH)的发病机制及临床表现,为治疗提供依据。方法:回顾性分析我院2006年10月～2010年10月收治的21例颅脑外伤开颅手术后并发迟发性颅内血肿患者的资料,迟发性颅内血肿的发生部位、发生时间等,并采取相应的治疗措施。结果:血肿发生部位为邻近型3例、远隔型8例、对侧型10例;发生在幕上19例,幕下2例;硬膜外血肿10例,脑内血肿8例,硬膜下血肿1例,硬膜下伴脑内血肿2例;治疗后恢复良好10例,轻度伤残3例,中度伤残2例,重度伤残1例,植物生存2例,死亡3例。结论:迟发性脑内血肿多发于患者伤后72 h内,血肿形成机制不尽相同,脑血管麻痹、低氧血症等是非手术区迟发性血肿形成的病理基础,及时行CT检查,早期发现及处理是降低患者死亡率的关键。

Objective： To investigate the pathogenesis and clinical manifestations of the delayed intracranial hematoma（DTIH） and provide the basis for the treatment.Methods： The clinical data of 21 patients from October 2006 to October 2010 in our hospital,the intracranial hematoma location and time were analyzed retrospectively,and take the appropriate therapeutic measures.Results： The site was adjacent type in 3 cases,distant in 8 cases,10 cases of contralateral type;19 patients with supratentorial and infratentorial in 2 cases;10 cases of epidural hematoma,intracerebral hematoma in 8 cases,1 case of subdural hematoma,subdural hematoma in 2 patients with intracerebral;good recovery after treatment in 10 cases,3 cases of mild disability,moderate disability in 2 cases,1 case of severe disability,vegetative state in 2 cases,3 cases died.Conclusion： The delayed intracerebral hematoma mainly in patients within 3 days after injury,hematoma formation mechanism is different,cerebral palsy,and other non-surgical areas hypoxemia delayed hematoma formation of the pathological basis,CT examination in a timely manner,early detection and treatment is the key to reduce the death rate in patients with critical residues.