外伤性急性硬膜下血肿快速自行消散12例报道及文献复习

Spontaneous resolution of acute traumatic subdural hematoma： a report of 12 cases and literature review

目的 总结外伤性急性硬膜下血肿快速消散的临床资料、诊疗经过,复习相关文献以提高对本病的认识. 方法 回顾性分析福建省龙岩市第二医院神经外科自2005年6月至2014年6月收治的病史和发病时间明确、临床资料完整的急性硬膜下血肿快速消散患者12例的临床资料,总结分析其治疗和预后. 结果 所有患者均采用非手术治疗,伤后24 h内血肿完全消失4例,明显减少8例.所有患者伤后72 h内血肿完全消失.患者平均住院时间18d.预后良好,出院时神经系统功能无缺损. 结论 对神志清楚、中线移位＜5 mm、血肿厚度均＜10 mm且无环池明显受压或消失的急性硬膜下血肿患者可以严密观察病情,动态CT监测.其快速消散的机制可能与脑脊液对血肿的稀释和颅骨骨折有关.

Objective To analyze the clinical data and treatment of spontaneous resolution of acute traumatic subdural hematoma,and review the relative literatures to improve the knowledge of the disease.Methods The clinical manifestation,images,treatment and prognosis of 12 patients with spontaneous resolution of acute traumatic subdural hematoma,admitted to our hospital from June 2005 to June 2014,were concluded and analyzed.Results Non-surgical treatment was adopted in all the patients;complete obliteration ofhematoma within 24 h of injury was noted in 4 and obvious decrease was noted in 8;complete obliteration of hematoma in all patients was achieved within 72 h of injury.Average days of hospitalization was 18.All patients enjoyed good prognosis and no system function defects were noted at discharge.Conclusion Patients with acute traumatic subdural hematoma of sane,middle shift〈5 mm,hematoma thickness〈10 mm and no cistema apparent oppression or disappearance may need conservation management with close clinical observation and dynamic CT images.Whose possible mechanisms of spontaneous resolutionmay might be associated with the dilution of cerebrospinal fluid and the fracture of skull.