外伤性急性硬膜下血肿的预后因素探讨

Evaluation of prognostic factors for traumatic acute subdural hematoma

目的探讨影响外伤性急性硬膜下血肿(ASDH)预后的因素。方法术后3个月,113例外伤性急性硬膜下血肿病人分为预后良好组(F组)和预后不良组(non-F组),对其术前资料进行回顾性分析比较。结果F组的年龄低于non—F组(P<0.05),GCS评分低于后者(P<0.01);瞳孔光反射阳性率和中脑周围池开放率高于后者(P<0.05).而伴随的脑挫伤、脑内血肿,蛛网膜下腔出血的发生率(P<0.05)及中线移位程度(P<0.01)低于后者。结论年龄、GCS评分、瞳孔对光反射和中脑周围池形态、中线移位程度及伴随颅内损伤的复杂、严重程度与ASDH病人预后有关,而瞳孔变化和CT影像学所提示的征象是反映ASDH病人预后的最为重要的因素。

Objective To explore prognostic factors related to traumatic acute subdural hematoma. Methods 3 months after surgical evacuation, 113 patients with traumatic acute subdural hematoma (TASDH) were divided into one group with functional prognostic outcome (F group) and the other with non-functional outcome (non-F group). The clinical data between the 2 groups were compared including such factors as age, admission GCS score, pupillary response and brain CT findings. Results Patients in F group were younger in age (P<0.05), lower in GCS scores (P<0.01), higher in positive incidence of papillary reactivity (P<0.05) and higher in incidence of open paramesencephalic cisterns (P<0.05) than those in non-F group. But those in the former group were more significant in midline shift (P<0.01) and higher in incidence of associated intracranial injuries (cerebral contusion, cerebral hematoma and subarachnoid hemorrhage) (P<0.05) than those in the latter. Conclusion Such factors as age, GCS score, pupillary response, status of paramesencephalic cisterns, extent of midline shift and complication and severity of associated intracranial injuries are closely related to TASDH patients' outcome. Pupillary response and brain CT findings are the most important factors for predicting outcome