颅脑损伤术后迟发性颅内血肿发生原因和手术治疗

Surgical treatment of postoperative delayed intracranial hematoma in patients with craniocerebral injury

目的探讨颅脑损伤术后迟发性颅内血肿的发生机制、手术指征及手术方式,以提高颅脑损伤救治成功率。方法回顾性分析2008年1月至2012年1月因颅脑损伤术后迟发性颅内血肿再次手术治疗的24例患者的临床资料,分析其可能的发生机制、临床特点,探索出早期诊断颅脑损伤术后迟发性颅内血肿的方法,并评估二次手术治疗的疗效。结果脑挫裂伤、颅骨骨折、压力填塞效应消失、凝血功能异常、手术操作不当及性别差异是颅脑损伤术后迟发性颅内血肿的常见病因。二次手术后6个月患者格拉斯哥预后评分(GOS):5分(良好)7例、4分(中度病残)8例、3分(重度病残)3例、2分(植物生存)2例、1分(死亡)4例。结论脑挫裂伤、颅骨骨折是颅脑损伤术后迟发性颅内血肿发生的重要病理基础,压力填塞效应的消失是其形成的主要原因。动态监测骨窗压力、引流量的变化,及时复查颅脑CT,可以提高颅脑损伤术后迟发性颅内血肿的早期诊断率。及时手术治疗,可以降低颅脑损伤术后迟发性颅内血肿的致残率和病死率,改善重型颅脑损伤患者的预后。

Objective To review the mechanism, surgical indication and treatment of postoperative delayed intracra- nial hematoma craniocerebral injury in patients with craniocerebral injury. Methods The clinical data of 24 craniocerebral injury patients with postoperative delayed intracranial hematoma, who underwent secondary surgical treatment from January 2008 to January 2012, were retrospectively reviewed. The possible mechanism, clinical characteristics, early diagnosis and efficacy of secondary surgical treatment of postoperative delayed intracranial hematoma were analyzed. Results The cerebral contusion and laceration, skull fracture, pressure-vanished effect, coagulant function abnormality, improper operation and gender differ- ences are the common causes of postoperative delayed intracranial hematoma. After 6 months of treatment the G^S scores showed 5 （good） in 7 cases, 4 （moderate disability） in 8 cases, 3 （severe sick） in 3 cases, 2 （persistent vegetative state） in 2 cas- es and 1（death） in 4 cases. Conclusion The cerebral contusion and laceration, skull fracture is an important pathological basis of postoperative delayed intracranial hematoma in patients with craniocerebral injury and the lost of pressure tamponade effect is the main cause for its formation. Timely surgical treatment can reduce the morbidity and mortality, improve the prognosis of pa- tients.