Outcome of Surgically Treated Acute Traumatic Epidural Hematomas Based on the Glasgow Coma Scale

This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural hematomas. The mean age of patients was 29.56 years and 63.04% of the patients were between 21 and 30 years of age. Forty-tree out of 46 (93.47%) of the patients were males. Road traffic crash was the main mode of injury. The severity of the traumatic brain injury was classified according to the Glasgow coma scale score at admission. The injury was mild or moderate in 35 (76.08%) cases and severe in 11. Eight patients (17.39%) presented with pupillary abnormalities. The computed tomography scanning of the head has objectivized the epidural hematoma in all patients and has shown a mass effect with midline shift in all but one case (45/46). The most frequent surgical procedure done was craniotomy. Six (13.04%) patients died (GOS 1), but 38 (82.60%) recovered fully (GOS 5) and two (04.34%) were disabled but independent (GOS 4). The Glasgow coma score at admission was very predictive for good or poor outcome, since all patients but one who died and all survivors who were disabled were comatose at admission (GCS ≤ 8).

The Use of Hinged Craniotomy in Comparison to Cisternostomy for Avoiding Bone Flap Replacement Second Surgery in Cases of Decompressive Craniotomy in Traumatic Brain Injury

Introduction: Acute post traumatic subdural hematoma is a clinical condition with increased morbidity and mortality despite the developments in neurosurgery and urgent intervention is required to have best clinical outcome. We will evaluate hinged craniotomy technique in terms of offering adequate brain decompression plus avoiding removal of bone flap which requires second replacement surgery in comparison to cisternostomy effect. Material and Methods: A prospective study was conducted over 30 patients with traumatic acute subdural hematoma presented to neurotrauma unit in Cairo University hospitals from January 2017 to February 2018, operated by hinged craniotomy plus evacuation of hematoma and duroplasty. We avoid rapping the head with elastic bandage post-operative. Generous subcutaneous dissection (5 - 7 cm) all around skin flap was done routinely. Effect of brain decompression was evaluated by measuring the level of brain in relation to skull in post-operative computerized topography. Results: Twenty-one patients operated with initial GCS less than eight. Ten cases (33%) show that cortical surface in relation to skull bone was at inner table, nine cases (30%) at diploid layer and two cases (6.7%) at outer table in post-operative CT brain. Twenty patients died (66.7%);eight patients (26.6%) became fully conscious and two patients (6.7%) had vegetative outcome. No re-operation was done in any of our patients. Conclusion: Hinged craniotomy may be a safe and effective alternative technique with comparable results to cisternotomy in cases of traumatic brain injury that require decompression to avoid second surgery, especially in centres lacking cisternostomy experience. Although gaining cisternostomy experience may help in other indications, future prospective studies with larger number are required.

Conservative Plan for Post Traumatic Extradural Hematoma: Risk Factors Favouring Conversion to Surgery

Introduction: Extradural hematoma (EDH) is considered one of the most serious and recognized secondary insults of traumatic brain injury (TBI). We will analyse the data of cases required conversion from a conservative to a surgical management and identify the possible patient and disease related risk factors in such cases. Patients and Methods: This prospective study included 90 patients with traumatic EDH, admitted to the Neurotrauma department in Cairo University hospitals from March 2014 to August 2016. Their CT scans reveal EDH alone or with associated cerebral lesions initially fitting the criteria of conservative management. Results: The commonest site is frontal in 21 patients (23.3%), followed by parietotemporal in 18 patients (20%). While Posterior fossa hematomas occurred in 3 cases, which was the least common site (3.3%). The mean size of the EDH was 17.02 ml, with a standard deviation of 6.29 ml. The minimum size was 2 ml and a maximum of 28 ml. The cut off value of the size of the hematoma requiring conversion to a surgical management was 19 ml. Conclusion: Clear indications of EDH evacuation have been well known, however studying which risk factors are more liable to convert conservative management plan to evacuation is important. Increased caution and closer monitoring are required when the size of the hematoma is >19 ml or the hematoma is overlying a venous sinus. Unlike coagulopathy which was found to be a potential risk factor, but larger number study is needed.

Management and Outcome of Acute Subdural Hematoma in Gabriel TouréHospital

Background: Traumatic Brain Injury (TBI) is a major health problem worldwide. It is the main cause of trauma mortality. Acute subdural hematoma (ASDH) has a reputation for being the most serious of all posttraumatic head injuries. Its frequency is estimated to be 1% to 5% of all head injuries and 22% of severe head injuries. The aim of this study was to assess the epidemiological, clinical and prognosis aspects of ASDH in our department. Material and Methods: This prospective study, from January to December 2019, included 57 patients admitted to the Gabriel Touré Teaching Hospital for ASDH. Patients underwent detailed clinical and radiological evaluation and ASDH was diagnosed by non-contrast computed tomography (CT) scan. Functional outcome was evaluated 6 months after injury by Glasgow Outcome Scale. Results: During the study period, 662 patients were admitted for TBI including 57 (8.61%) cases of ASDH. The mean age was 34 years with extremes of 2 and 77 years. There was a male predominance with 52 (91.2%). The main cause of trauma was motor vehicle accidents in 38 (66.6%) patients. According to the Glasgow coma scale (GCS), 33 (57.9%) patients were classified mild (Table 2). The thickness of the hematoma was more than 1 cm in 13 (22.8%) patients and less than 1 cm in 44 (77%) patients. Surgical treatment was performed in 13 (22.8%) patients. The outcome was favorable in 30 (52.6%) patients and the mortality rate was 33.3%. Conclusion: ASDH remains a difficult challenge because of the high mortality. The mortality rate remains high particularly in patient with poor GCS score at admission.

Surgical Outcome of Extradural Hematoma Patients in Relation to Preoperative Neurological Status

Introduction: Epidural hematoma (EDH) is characterized by the acute onset of traumatic haemorrhage into potential space between the dura mater and skull following head injury. About 85% of the epidural cases are caused by skull fracture with rupture of the middle meningeal artery or its branches and rest of 1the time ruptured venous sinuses, fractured diploic bone. The BTF recommends that all patients with an EDH volume of greater than 30 cc should undergo surgical evacuation regardless of Glasgow Coma Scale (GCS). Aim of the Study: To assess the surgical outcome of extradural hematoma patients by using Glasgow Outcome Scale (GOS) postoperatively. Material & Methods: This prospective study was conducted in the Department of Neurosurgery, Dhaka Medical College and Hospital (DMCH), during the period of January 2016 to December 2017. A total of 98 patients of both sex and any age with EDH were selected purposively. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 22.0 for Windows (SPSS Inc., IBM and New York, USA). Prior to commencement of this study, the “Research Review Committee” & the “Ethical Committee” of DMCH, Dhaka, approved the research protocol. Results: In this study, 98 patients were included;they were divided into 6 groups. Age range was 04 - 55 years. It was observed that majority, 30 (30.60%) patients were from 21 - 30 years of age. The mean age was found 25.24 ± 12.2 years. Other age related distributions were shown in the table. Male patients were 78 (78.55%) and 22 (22.44%) patients were female. A male predominance was observed. Among admitting GCS 3-8, 56.25% patients had unfavorable outcome and 43.25% had favorable outcome. Admitting GCS 9-13, 2.5% patients had unfavorable outcome and 97.5% had favorable outcome. Admitting GCS 14-15, all patients (100.0%) had favorable outcome. Unfavorable outcome was observed in 9 (9.18%), 1 (1.00%) patients who belong 3-8, 9-13 GCS on admission. Mean GCS on admission was found 6.7 ± 2.44 score in unfavorable outcome group and 13.45 ± 2.30 score in favorable outcome group. Conclusion: This study revealed good surgical outcome in extradural hematoma patients. Preoperative GCS is an important predictor of outcome. Other preoperative neurological statuses like pupillary changes, neurological focal deficit, cranial nerve involvement, plantar reflexes and seizure also influence the surgical outcome.

经眉弓锁孔入路完全神经内镜下手术治疗外伤性额叶血肿的疗效

目的探讨经眉弓锁孔入路完全神经内镜下手术治疗外伤性额叶血肿的疗效。方法回顾性分析2022年1月至2022年12月经眉弓锁孔入路完全神经内镜下手术治疗的7例外伤性额叶血肿的临床资料。结果入院时GCS评分6~13分,平均(10.4±2.7)分;出血量30~40 ml,平均(37.9±3.9)ml。骨窗大小约2 cm×3 cm;手术时间62~80 min,平均(70.3±6.1)min。出院时,6例GCS评分15分,1例13分。出院后随访1年,1例术后9个月出现癫痫发作,口服丙戊酸钠缓释片控制良好,其余6例正常生活。结论经眉弓锁孔入路完全内镜下手术治疗外伤性额叶血肿具有微创、高效、操作方便等优点,但需严格把握适应证,对脑疝病人不适用。

Risk factors associated with the progression of extra-axial hematoma in the original frontotemporoparietal site after contralateral decompressive surgery in traumatic brain injury patients

Purpose:To introduced our experience with progressive extra-axial hematoma(EAH)in the original frontotemporoparietal(FTP)site after contralateral decompressive surgery(CDS)in traumatic brain injury patients and discuss the risk factors associated with this dangerous situation.Methods:This retrospective study was conducted on 941 patients with moderate or severe TBI treated in Daping Hospital,Army Medical University,Chongqing,China in a period over 5 years(2013e2017).Only patients with bilateral lesion,the contralateral side being the dominant lesion,and decompressive surgery on the contralateral side conducted firstly were included.Patients were exclude if(1)they underwent bilateral decompression or neurosurgery at the original location firstly;(2)although surgery was performed first on the contralateral side,surgery was done again at the contralateral side due to rebleeding or complications;(3)patients younger than 18 years or older than 80 years;and(4)patients with other significant organ injury or severe disorder or those with abnormal coagulation profiles.Clinical and radiographic variables reviewed were demographic data,trauma mechanisms,neurological condition assessed by Glasgow coma scale(GCS)score at admission,pupil size and reactivity,use of mannitol,time interval from trauma to surgery,Rotterdam CT classification,type and volume of EAH,presence of a skull fracture overlying the EAH,status of basal cistern,size of midline shift,associated brain lesions and types,etc.Patients were followed-up for at least 6 months and the outcome was graded by Glasgow outcome scale(GOS)score as favorable(scores of 4e5)and unfavorable(scores of 1e3).Student's t-test was adopted for quantitative variables while Pearson Chi-squared test or Fisher's exact test for categorical variables.Multivariate logistic regression analysis was also applied to estimate the significance of risk factors.Results:Initially 186 patients(19.8%)with original impact locations at the FTP site and underwent surgery were selected.Among them,66 met the inclusion and exclusion criteria.But only 50 patients were included because the data of the other 16 patients were incomplete.Progressive EAH developed at the original FTP site in 11 patients after the treatment of,with an incidence of 22%.Therefore the other 39 patients were classified as the control group.Multivariate logistic regression analysis showed that both the volume of the original hematoma and the absence of an apparent midline shift were significant predictors of hematoma progression after decompressive surgery.Patients with fracture at the original impact site had a higher incidence of progressive EAH after CDS,however this factor was not an important predictor in the multivariate model.We also found that patients with progressive EAH had a similar favorable outcome with control group.Conclusion:Progressive EAH is correlated with several variables,such as hematoma volumes10 mL at the original impact location and the absence of an apparent midline shift(<5 mm).Although progressive EAH is devastating,timely diagnosis with computed tomography scans and immediate evacuation of the progressive hematoma can yield a favorable result.

去骨瓣减压联合着力部位硬膜外血肿清除治疗对冲性重症颅脑损伤的效果观察

目的:观察去骨瓣减压联合着力部位硬膜外血肿清除治疗对冲性重症颅脑损伤的临床效果。方法:选取福建省福清市医院2020年1月—2023年2月收治的216例对冲性重症颅脑损伤患者,按照随机数字表法分为研究组和对照组,各108例。对照组采用去骨瓣减压联合常规开颅血肿清除治疗,研究组采用去骨瓣减压联合着力部位硬膜外血肿清除治疗。对比两组临床症状、预后、意识状态、术后并发症、创伤应激反应。结果:研究组预后良好率和术后7 d格拉斯哥昏迷量表(GCS)评分均高于对照组,术后7 d对侧血肿厚度及中线移位均小于对照组,术后7 d颅内压、术后并发症发生率及术后7 d肾上腺素(E)、β-内啡肽(β-EP)、皮质醇(Cor)水平均低于对照组(P<0.05)。结论:去骨瓣减压联合着力部位硬膜外血肿清除治疗对冲性重症颅脑损伤效果显著,不仅能够清除患者脑血肿,降低颅内压,减轻中线移位和创伤应激,还可改善患者意识状态,减少术后并发症发生,改善预后。

儿童急性硬膜下血肿继发大面积脑梗死危险因素分析

目的 分析急性硬膜下血肿(acute subdural hematoma,ASDH)术后继发大面积脑梗死患儿的临床表现和影像学特征,评估其潜在危险因素,为ASDH术后继发大面积脑梗死的预防、早期诊断和治疗提供依据。方法 回顾性研究4~12岁ASDH患儿的临床资料,所有患儿接受常规手术治疗。创伤后继发大面积脑梗死(massive cerebral infarction,MCI)是基于CT影像上低密度区域及临床体征诊断。回顾与患者预后相关的临床和影像学表现并进行统计学比较。采用多因素Cox回归分析对术后MCI进行初步评价,得出影响MCI的因素。结果 共纳入病例67例,32例列入MCI组,非MCI组35例。两组年龄(t=2.016,P=0.048)、体质量(t=2.389,P=0.020)、多发伤(χ^(2)=11.121,P=0.001)、GCS(Z=-4.730,P<0.001)、血肿体积(χ^(2)=12.890,P=0.002)、中线偏移度(mid-line shift,MLS;χ^(2)=12.261,P=0.002)及围手术期休克(χ^(2)=14.417,P<0.001)差异具有统计学意义。GCS(OR=0.322,P=0.002)、围手术期休克(OR=10.992,P=0.007)、多发伤(OR=6.547,P=0.046)与MLS (OR=46.974,P=0.025)是ASDH患儿发生MCI的主要风险因素。结论 围手术期休克、合并多发伤、GCS低评分和MLS大于10 mm是MCI的危险因素。具有多种危险因素的患儿MCI发生率显著提高。

高原地区急性进展型硬膜外血肿致脑疝1例

急性硬膜外血肿(AEDH)是颅脑损伤后3 d内在硬脑膜和颅骨内板之间的潜在空间中出现的血肿。部分AEDH病例为进展型,早期症状较轻或被对冲伤症状掩盖,首次头颅CT检查未发现硬膜外血肿或血肿量较小,经过一段时间后复查头颅CT出现血肿或血肿增大,病情严重者,甚至出现脑疝,危及病人生命。本文报道1例高原地区的AEDH,为50岁男性,因高处坠落伤致头痛、头晕伴恶心呕吐0.5 h入院,GCS评分14分,首次头颅CT示左侧侧裂区片状高密度影,左侧颞枕部颅板下气体影,其内夹杂少量硬膜外血肿,右侧颞底硬膜下弧形高密度影。入院后6h发生病情变化,GCS评分7分,左侧瞳孔散大至5mm、对光反射消失,复查头颅CT示左侧颞枕部大面积硬膜外血肿形成,中线明显右移,左侧侧脑室受压变形。急诊全麻下行开颅血肿清除术。术后2 h复查头颅CT示左侧颞枕部硬膜外血肿清除彻底。术后6个月随访,病人GOS评分5分。这提示颅脑损伤病人,具有手术指征时要及早行开颅减压和血肿清除术。

颅脑外伤患者去骨瓣减压术后早期颅内血肿进展的影响因素

目的分析颅脑外伤患者早期颅内血肿进展的相关因素。方法分析2018年6月—2022年6月期间鹤壁市人民医院采用去骨瓣减压术治疗的180例颅脑外伤患者,依据是否出现早期颅内血肿进展分为进展组(n=54)和对照组(n=126),采用多因素Logistic回归分析这些患者早期颅内血肿进展的影响因素。结果分析结果显示,多发性血肿、术前血肿量≥20 cm^(3)、纤维蛋白原<2 g/L为颅脑外伤患者早期颅内血肿进展的危险因素(P<0.05)。结论多发性血肿、术前血肿量≥20 cm^(3)、纤维蛋白原<2 g/L为颅脑外伤患者去骨瓣减压术后早期颅内血肿进展的危险因素,临床中应对高危患者加强监测。

应激系统理论的教育干预对外伤性硬膜外血肿患者心理弹性和睡眠质量的影响

目的:对外伤性硬膜外血肿(TEH)患者实施应激系统理论的教育干预,分析其对心理弹性和睡眠质量的影响。方法:按照入院先后将某院2020年1月-2023年1月收治的80例TEH患者分为对照组(n=40,常规干预)和观察组(n=40,常规干预+应激理论的教育干预);对比两组干预效果,干预前后心理弹性[心理弹性量表(CD-RISC)]、睡眠质量[匹兹堡睡眠质量指数量表(PSQI)]、神经功能[美国国立卫生研究院卒中量表(NIHSS)]和生活质量[世界卫生组织生存质量测评量表(WHO-QOL-100)]及患者满意度。结果:观察组致残率、并发症总发生率均低于对照组(χ^(2)=4.114,7.314;P<0.05));干预后,观察组坚韧、乐观、自强及CD-RISC量表总分均高于对照组(t=3.734,4.382,3.465,6.585;P<0.05);干预后,观察组PSQI各维度评分及总分均低于对照组(t=-2.575,-3.741,-2.684,-2.504,-2.527,-2.268,-2.158,-7.946;P<0.05);干预后,两组NIHSS评分均低于干预前(P<0.05),且观察组低于对照组(t=-7.375,P<0.05);两组WHO-QOL-100评分均升高(P<0.05),且观察组高于对照组(t=2.126,P<0.05)。两组满意度比较,观察组为97.50%,高于对照组的80.00%(χ^(2)=4.507,P<0.05)。结论:对外伤性硬膜外血肿患者采用基于应激理论的教育干预效果显著,可降低致残率和并发症发生率,提高患者心理弹性,改善睡眠质量、神经功能和生活质量,提升患者满意度。

经锁孔入路神经内镜血肿清除术对颅脑外伤伴脑出血患者神经功能和血清SAA、谷氨酸、γ-氨基丁酸水平的影响

目的 探讨经锁孔入路神经内镜血肿清除术对颅脑外伤(TBI)伴脑出血(ICH)患者神经功能和血清淀粉样蛋白A(SAA)、谷氨酸、γ-氨基丁酸水平的影响。方法 选取2020年4月至2023年4月本院收治的TBI伴ICH患者114例,根据随机数字表法分为观察组(57例,行经锁孔入路神经内镜血肿清除术)与对照组(57例,行传统开颅血肿清除术)。比较两组临床疗效,手术相关指标,采用NIHSS评分、Fugl-Meyer评定量表、Barthel指数分别评估患者神经功能缺损程度、平衡能力、日常生活活动能力,并检测血清SAA、谷氨酸和γ-氨基丁酸水平,记录术后并发症发生情况。结果 两组手术时间、住院时间经统计学分析差异无统计学意义(P>0.05);与对照组比较,观察组术中出血量较少、血肿清除率较高(P<0.05)。观察组总有效率为高于对照组(P<0.05)。术后1个月,与对照组比较,观察组总有效率较高,NIHSS评分较低,Fugl-Meyer量表、Barthel指数评分较高(P<0.05)。术后24 h,观察组血清SAA、谷氨酸水平低于对照组,γ-氨基丁酸水平高于对照组(P<0.05)。观察组与对照组术后并发症发生率差异无统计学意义(P>0.05)。结论 经锁孔入路神经内镜血肿清除术治疗TBI伴ICH效果显著,可显著改善患者神经功能,提高患者生活活动能力。

Role of Computed Tomographic Scanning in Pediatric Head Injury: An Observational Cohort of Data of 60 Patients

Pediatric head injury is one of the major health problems. That can be easily evaluated by computed tomographic scanning. This study describes the various findings of pediatric head trauma seen on CT scan, the timely diagnosis of which plays a vital role in prognosis, especially in semiurban and remote location where the decision for tertiary referral is important. Timely intervention in traumatic brain injury cases reduces morbidity and mortality. Cerebral edema, which is the most common intracranial lesion, can be promptly managed by medicosurgical support with ICP monitoring, thereby improving the overall prognosis. Other lesions commonly seen are subdural hematomas and skull fractures. Limitations of radiographs, ultrasound and MRI in these acute cases, highlight the benefit of CT scans.

脑挫裂伤伴血肿形成的手术预后因素分析

目的 创伤性脑挫裂伤通常较为严重,但没有明确的预后预测因素。本研究的目的是观察创伤性脑挫裂伤伴双侧血肿形成的预后影响因素,并进一步探讨影响死亡率和临床结局的因素。方法 回顾性分析2018年2月至2022年8月行双侧同期或序贯手术的102例创伤后颅内血肿患者的临床资料,观察指标包括术中、术后疗效评价。术中影响因素包括:术中输血量、血肿清除程度、手术时间、术中低血压。术后效果评价指标如下:GCS评分变化,围手术期因素,如肺炎发生率、再出血率、颅内感染、二次手术率、住院时间。结果 共纳入102例患者。单因素分析显示,女性、就诊时GCS较低、存在中线移位等因素与术中低血压等因素与死亡率相关,而多发伤、贫血、高血糖、凝血功能障碍和围手术期因素如首次手术时间、手术侧位、手术间隔时间、失血量和开颅/开颅状态不影响生存率;在多因素Logistic回归模型中男性、GCS分数较高、术中低血压是影响死亡率的三个独立危险因素。结论 本研究进一步研究了影响死亡率和临床结局的因素,创伤后急性脑挫裂伤对生存和临床结局有显著影响。创伤后脑挫裂伤双侧血肿病变的治疗决策至关重要,应基于现有指南,并结合患者的临床情况进行决策。

微创引流术治疗在脑外伤硬脑膜外血肿患者中的应用

目的分析微创引流术在脑外伤硬脑膜外血肿患者中的应用价值。方法选择2020年1月—2022年12月淄博市中心医院神经外科收治的96例患者为研究对象,随机分为两组,每组48例。观察组采用微创引流术治疗,对照组采用传统手术治疗。对比两组患者生活质量、术后相关指标、神经功能缺损指标、并发症发生率。结果观察组躯体功能等指标评分均高于对照组,差异有统计学意义(P<0.05)。观察组手术相关指标均优于对照组,差异有统计学意义(P<0.05)。观察组术后1 d神经功能缺损评分低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为2.08%,低于对照组的18.75%,差异有统计学意义(χ^(2)=7.144,P<0.05)。结论采用微创引流术治疗脑外伤硬脑膜外血肿患者方式,有利于提升患者生活质量,降低并发症发生率。

脑外伤迟发性脑内血肿微创治疗效果研究

目的 探讨脑外伤迟发性脑内血肿患者采取微创颅骨钻孔硅胶引流管引流术治疗的临床效果与价值。方法 方便选择2018年6月—2022年7月如东县中医院神经外科收治的脑外伤迟发性脑内血肿患者89例作为研究对象,根据随机数字表法分为对照组(44例)与观察组(45例)。对照组采取开颅去骨瓣减压联合颅内血肿清除术治疗,观察组采取微创颅骨钻孔硅胶引流管引流术治疗,测定两组患者术后3、15 d病灶周围水肿面积,对患者进行为期3个月的跟踪随访,评估对比两组患者预后质量及生活质量评分差异。结果观察组患者术后3、15 d病灶周围水肿面积均小于对照组,差异有统计学意义(P<0.05)。通过3个月调查随访,观察组患者总残疾率(31.11%)低于对照组,差异有统计学意义(χ^(2)=5.972,P<0.05)。观察组患者生活质量各分项评分结果均高于对照组,差异有统计学意义(P<0.05)。结论 临床治疗脑外伤迟发性脑内血肿疾病可首选微创颅骨钻孔硅胶管引流术治疗,可促进患者脑水肿面积的减小,同时促进患者预后恢复,提高生活质量。

儿童颅脑外伤术后凝血功能障碍的影响因素分析

目的探讨儿童创伤性硬膜外血肿清除术后发生凝血功能障碍的影响因素。方法选取2016年2月至2022年6月在首都医科大学附属北京儿童医院行硬膜外血肿清除术的93例患儿,根据术后是否发生凝血功能障碍分为正常组和障碍组,采用多因素logistic回归方程分析创伤性硬膜外血肿清除术后凝血功能障碍的影响因素。结果93例患儿中,男60例,女33例,年龄0~15岁,平均(4.4±3.7)岁,术后发生凝血功能障碍33例,发生率35.48%。多因素logis⁃tic回归分析结果显示,术前的HCT越低(OR=0.898,95%CI:0.831~0.971,P=0.007)、PLT越低(OR=0.984,95%CI:0.973~0.994,P=0.003)和PT越长(OR=4.524,95%CI:1.956~10.467,P=0.000)的患儿,创伤性硬膜外血肿清除术后发生凝血功能障碍的风险越大。结论创伤性硬膜外血肿清除术后患儿发生凝血功能障碍较常见,术前HCT和PLT降低、PT延长是患儿术后凝血功能障碍产生的危险因素。

静脉注射氨甲环酸对颅脑损伤患者颅内血肿及预后的影响

目的 评估早期静脉注射氨甲环酸对创伤性颅脑损伤合并颅内出血患者的疗效。方法 前瞻性研究2021年8月-2022年5月华中科技大学同济医学院附属同济医院创伤外科收治创伤性颅脑损伤合并颅内出血患者74例,男性患者51例,占比68.9%。将纳入患者按随机数字表法1∶1分为实验组及对照组,实验组损伤后3h内予以1g氨甲环酸10min内缓慢静推,然后予以1g氨甲环酸持续输注8h;对照组以安慰剂(0.9%生理盐水)按实验组同样方式处理。通过入院时和伤后48h的头颅CT平扫比较两组患者颅内血肿的改变,同时比较两组患者病死率、血管闭塞事件及后遗症发生率等临床指标,综合评估患者临床结局。结果 两组患者一般资料中年龄、性别、致伤机制、GCS及GCS人群分布情况等指标未见明显组间差异(P均>0.05)。实验组平均住院天数较对照组少[(16.8±13.3)dvs.(23.0±17.7)d,P<0.05]。实验组接受手术治疗的比例较对照组低(8.1%vs. 27.0%,P<0.05)。入院48h后头部CT示实验组颅内血肿体积较入院时明显减少,而对照组入院48h后颅内血肿体积较前稍增多,两组间比较差异有统计学意义[5.1(2.2,28)vs. 9.8(2.8,48.3),P<0.05]。两组患者院内病死率、血管栓塞事件等并发症及伤后3个月后遗症发生率等指标比较差异无统计学意义(P>0.05)。结论 静脉注射氨甲环酸治疗对颅脑损伤患者安全有效,规范化的早期用药可以有效减少血肿体积、降低手术治疗率、缩短住院时间等,同时不会增加患者后遗症及血栓闭塞事件等并发症发生率。

着力部位EH、SDH单侧清除术联合DC对重型颅脑损伤的效果观察

目的 探讨着力部位硬膜外血肿(EH)、硬膜下血肿(SDH)单侧清除术联合去骨瓣减压术(DC)对重型颅脑损伤(sTBI)患者颅内血流动力学及短期预后的影响。方法 选取2018年6月—2022年10月收治的201例sTBI作为研究对象,按照治疗方式的不同分为观察组(予着力部位EH、SDH单侧清除术联合DC治疗)107例和对照组(予单侧颞额部血肿清除术联合DC治疗)94例。比较2组术后临床疗效,手术前后颅内血流动力学指标[大脑中动脉收缩期峰值流速(Vs)、平均血流速度(Vm)和搏动指标(PI)],手术前后视神经鞘直径(ONSD)、格拉斯哥昏迷量表(GCS)评分,以及短期预后和术后并发症发生率。结果 观察组术后总有效率(95.33%,102/107)高于对照组(85.11%,80/94)(P<0.05)。术后2组Vs、Vm均升高,PI均降低;术后观察组Vs、Vm高于对照组,PI低于对照组(P<0.01)。术后2组ONSD均较术前缩短,且观察组短于对照组(P<0.01);术后2组GCS评分均较术前升高,且观察组高于对照组(P<0.01)。观察组术后1个月预后良好率高于对照组,术后并发症总发生率低于对照组(P<0.01)。结论 着力部位EH、SDH单侧清除术联合DC治疗能改善sTBI患者颅内血流动力学指标和短期预后,降低术后并发症发生率。