“无症状”硬膜外血肿的治疗  

The treatment of "asymptomatic" epidural hematoma

作　　者：张洪琛[1] 孙学武[1] 李元柱[1] 

机构地区：[1]天津市蓟县人民医院神经外科,301900

出　　处：《河北医药》2006年第4期258-259,共2页Hebei Medical Journal

摘　　要：目的探讨对入院时血肿量较小而无颅内压增高和局限性神经功能缺损的患者进行保守治疗的指标。方法回顾性分析22例患者的年龄、性别、GCS评分、伤后头部CT检查的时间及骨折线是否经过脑膜动、静脉或静脉窦与病情恶化的关系。结果患者的年龄、性别、GCS评分、最初血肿大小均不是病情恶化的危险因素。但有骨折线经过脑膜动、静脉或静脉窦,且伤后6h内行头部CT检查的患者,71%病情恶化,需要手术治疗。结论小量硬膜外血肿患者如果骨折线经过脑膜动、静脉或静脉窦和(或)诊断在伤后6 h内做出,那么就存在病情恶化和需要手术清除血肿的危险。Objective To investigate the indications of non-surgical treatment for the patients whose epidural hematoma were too small to cause clinical symptoms of raised intracranial pressure or focal neuro-dysfunction when admission. Methods 22 patients were included in this retrospective study. To evaluate the relation between prognosis and the following risk factors：the age, sex, Glasgow Coma Scale and initial size of the hematoma, when the CT was given after injury, if a fracture was cross a major vessel or major sinus. Results 71% of patients with a skull fracture across meningeal artery vein or major sinus, the CT given within 6 hours after trauma indicated a surgery treatment, however the factors of age, sex, Glasgow Coma Scale, and initial size of the hematoma were not. Conclusion The patients admitted with small epidural hemaotoma, who have an evidence of a fracture overlaying a major vessel or major sinus, and/or who are diagnosed by CT less than 6 hours after trauma need an intensive care and indicated to a surgery treatment.

关 键 词：硬膜外血肿 骨折 创伤性脑损伤 

分 类 号：R651.15[医药卫生—外科学] R541.4[医药卫生—临床医学]