外伤性迟发性颅内血肿62例诊治体会

Treatment of the Delayed Posttraumatic Intracranial Hematoma for 62 Cases

目的:探讨外伤性迟发性颅内血肿的早期诊断及治疗效果。方法:回顾分析笔者所在医院收治的62例外伤性迟发性颅内血肿的发生机理、早期诊断和治疗效果。结果:对幕下血肿大于10ml,幕上血肿大于30ml且中线移位明显者48例施行开颅血肿清除加去骨瓣减压术,伤后6个月GOS评估法判定其疗效:良好(5分)10例,中残(4分)16例,重残(3分)7例,植物生存(2分)6例,死亡(1分)9例,预后较好(良好、中残)占54.17%,预后较差或差(重残、植物生存、死亡)占45.83%。14例血肿较小、中线移位不明显者行非手术治疗,伤后6个月GOS评分:良好(5分)6例,中残(4分)4例,重残(3分)2例,植物生存(2分)1例,死亡(1分)1例。结论:对于外伤性迟发性颅内血肿,早期诊断能对其治疗起到一定作用,而动态CT监测是对其进行早期诊断的关键。

Objective：To study the early diagnosis and treatment of delayed posttraumatie intracranial hematoma.Method：To retrospectively analyse the occurrence mechanism, early diagnosis and treatment effect of 62 cases delayed posttraumatic intracranial hematoma. Result：For 48 patients with hematoma larger than 30 ml up tentorium of cerebellum or larger than 10 ml below tentorium of cerebellum and with obvious shift of median line, evacuation of hematoma and deeompressive craniotomy were performed.Of these, according to the Glasgow outcome scale at the end of month 6 after injury, there were 10 patients（GOS 5 points）with good recovery, 16（GOS 4 points）with moderate deficit, 7（GOS 3 points）with severe deficit.6 （GOS 2 points）under persistent vegetative status and 9（GOS 1 points）deaths.With good prognosis rate（good recovery and moderate deficit） of 54.17% and poor prognosis rate of 45.83%. For 14 patients with smaller hematoma and unobvious shift of median line, conservative treatment was performed.There were 6 patients（GOS 5 points）with good recovery, 4（GOS 4 points）with moderate deficit, 2（GOS 3 points）with severe deficit.1 （GOS 2 points）under persistent vegetative status and I（GOS 1 points）deaths.Conclusion：Early diagnosis can obviously improve the treatment effect of delayed posttraumatic intraeranial hematoina, and the dynamic CT monitoring is the key to early diagnosis for delayed posttraumatic intracranial hematoma.