老年人慢性硬脑膜下血肿诊治分析

Diagnosis and treatment of chronic subdural hematoma is old people

目的 总结老年人慢性硬脑膜下血肿诊治;方法 分析本文中56例慢性硬脑膜下血肿(CSDH)的病史、临床表现和治疗术式及治疗效果;结果 有些老年人慢性硬膜下血肿病例的外伤史不明显和临床症状和体征无特异性,容易造成误诊,本组56例中无明显外伤史19例(34％),临床表现主要是意识障碍和精神异常及神经病理征阳性;而治疗上选择术后留置引流管47例(84％),不留置引流管9例(16％);引出血性液测定纤维蛋白原降解产物(FDP)结果比静脉血正常值高出300-3000倍;结论 在临床诊断上有怀疑老年人慢性硬膜下血肿应作CT检查以排除或确诊该病;治疗上术后是否留置引流管应因人而定,各有利弊,彻底清除纤维蛋白原降解产物是治疗该病和预防复发的关键。

Objective: To summarize the features of diagnosis and treatment of chronic subdural hematoma in old people. Methods The history, clinical manifestation, treatment and effect was analyzed in 56cases of chronic subdural hematoma(CSDH). Results Traumatic history was not clear cut in some cases, and there were not specific in symptoms and signs, which was not easy to be diagnosed. 19 cases of 56(34%)had unobvious trau- matic histories, whose chief manifestation were conscious disturbance, abnormal mind, and positive pathologic signs. FDPcontent was 300 to 3000 times in drainage blood than in vein blood. Conclusions It is necessary to usc CT to decide CSDH. If the drainage tube should be indwelled, to do this is suitable to the occasion. Thor- ough removal of FDPis the key to treat and prevent CSDH.