85例慢性硬膜下血肿临床特征、CT表现与手术结果

85 cases Clinical characteristics of CSDH, images of CT and results of operation

目的 进一步探讨慢性硬膜下血肿 (CSDH)的临床特征、CT表现与手术结果。方法 对 85例 CSDH患者的临床特征、CT表现及手术结果进行分析 ,并分老年 CSDH与非老年 CSDH两组进行对照。结果 老年 CSDH组高血压病史、脑血管病史及头晕、反应迟钝、意识障碍、精神症状均明显较非老年性 CDSH组常见 (P<0 .0 5、P<0 .0 1)。老年 CSDH组血肿范围波及三个脑叶以上者 ,形态呈分隔型、密度呈混杂密度者明显较非老年 CSDH组多见 (P<0 .0 5 )。手术后的显效率 ,老年 CSDH组 (75 .4 3% ) ,明显低于非老年 CSDH组 (93.75 % ) ,P<0 .0 1。 2 0例分层、分隔型 CSDH中有 10例经二次手术、多孔引流后痊愈。结论 老年性 CSDH患者多为慢性颅内压增高起病 ,临床症状不典型易被误诊 ,出血量大 ,波及范围广 ,预后差。血液出凝血机制不良因素所致的非老年 CSDH患者更容易被误诊、漏诊 ,需引起高度警惕。要重视分隔型 CSDH的 CT诊断 ,并尽可能采用钻多孔引流或开颅清除术 ,改善其预后。

Objective To further study the clinical characteristics of CSDH,the images of CT and results of the operations.Methods Analyse the clinical characteristics,the images of CT and the results of the operations of 85 cases of CSDH.Compare the old group of CSDH with the younger one.Results Histories of hypertension,encephal vessel diseases,dizziness,slow reactions,mental disorders and mental conditions are more common in the old group than in the younger one ( P <0 05, P <0 01),and so are hematomas involving three or more lobes with the appearance of separation and mix dencity( P <0 05).The obvious effectiveness of the operations was less in the old group(75 43%) than in the younger one (93 75%) P <0 01.Ten cases out of twenty of'layering'and'separation'CSDH recovered after two operations and muiti hole drainage.Conclusion\ the increase of chronic cranial pressures may mainly be the causes in old patients.And misdiagnosis may be made because of the uncharacteristic clinical symptoms.The prognosis is poor owing to the extensive hemorrhage and the wide rage involved.We should be on the alert against the misdiagnosis or negligence of those old patients from the poor blood coagulation,pay attention to the CT diagnosis of the 'seperation'CSDH and drain through several holes of perform craniotomy to improve the prognosis.