自发性硬脊膜外血肿急诊救治现状分析

Analysis of emergency treatment of spontaneous epidural hematoma

目的分析自发性硬脊膜外血肿(SSEH)急诊救治现状,提出改善现状的对策。方法回顾性分析华中科技大学同济医学院附属协和医院神经外科自2015年3月至2019年11月行手术治疗的18例SSEH患者,对其临床表现、诊断方式和流程、出现神经功能障碍到手术时间间隔及手术后神经功能恢复情况进行总结。结果18例患者均在发病后不同时间出现了神经功能障碍,首发症状:14例为剧烈疼痛,1例为颈部无力,3例为胸部以下截瘫。所有患者最终通过MRI检查确认椎管内出血,从神经功能障碍到MRI检查的时间为2~120 h,平均43.3 h。患者经手术治疗,15例(83.3%)治愈,2例(11.1%)好转,1例(5.6%)无效。患者出现神经功能障碍到手术的时间间隔越长,疗效越差,神经功能恢复过程越长。结论提高首诊医师对SSEH的认识,及时进行MRI检查,有助于早期确诊和早期手术,促进神经功能恢复,减少后遗症。

Objective To analyze the emergency treatment for spontaneous spinal epidural hematoma(SSEH)and propose the countermeasures to improve the status quo.Methods Eighteen with SSEH who underwent surgery in the Department of Neurosurgery of Union Hospital Affiliated to Tongji Medical College of Huazhong University of science and technology from March 2015 to November 2019 were analyzed retrospectively,and their clinical features,diagnostic methods and procedures,the time interval from neurological dysfunction to surgery and the recovery of neurological function after surgery were summarized.Results All the 18 patients had neurological dysfunction at different time after the onset of the disease.The first symptoms were severe pain in 14 cases,neck weakness in 1 case and paraplegia below the chest in 3 cases.All patients finally confirmed intracerebral hemorrhage by MRI,and the time from neurological dysfunction to MRI was 2-120 h,with an average of 43.3 h.After surgical treatment,15 cases(83.3%)were cured,2 cases(11.1%)were improved and 1 case(5.6%)was invalid.The longer the time between the onset of neurological dysfunction and surgery,the worse the outcome and the longer the recovery process of neurological function.Conclusion Improving the understanding of SSEH among first-diagnosis physicians and timely conduct MRI examination is helpful to early diagnosis and early operation,promote the recovery of neurological function and reduce sequelae.