亚急性硬膜下血肿病理机制的再探讨  

Further Discussion on the Pathological Mechanism of Subacute Subdural Heamatoma

作　　者：陶志强[1] 高国一[2] 冯军峰[2] 毛青[2] 李剑伟[1] 丁胜鸿[1] 

机构地区：[1]温州医科大学附属义乌市中心医院神经外科,322000 [2]上海交通大学医学院附属仁济医院神经外科,200127

出　　处：《医学研究杂志》2015年第7期117-121,共5页Journal of Medical Research

摘　　要：目的：探讨亚急性硬膜下血肿的病理机制。方法结合笔者医院3例典型病例的临床资料，荟萃分析近15年相关文章。结果亚急性硬膜下血肿手术时机平均为12．5-15．5天，均数为14．1天。本组3个急性硬膜下血肿亚急性化的病例，都存在部分血肿凝块延迟液化的现象，1例使用地塞米松治疗效果良好，1例血肿清除术后引流不.致病情复发。结论急性硬膜下血肿亚急性化是一种时间规律性极强的炎性反应过程，推测是一种类似过敏反应性的机制：由血凝块液化过程释放的某种抗原，通过硬脑膜下新生膜细胞作为抗原递呈细胞，递呈给新生膜内从毛细血管内游离出的T淋巴细胞，形成致敏T淋巴细胞，当延迟溶解的血凝块释放后续抗原再次接触致敏T淋巴细胞时，类似Ⅳ型变态反应的炎性过程发生。Objective To explore the pathogenesis of subacute subdural heamatoma.Methods Articles focusing on the subacute subdural hematoma in recent 15 years were searched and the major clinical manifestations were analyzed.Typical clinical cases were also presented and factors influencing the enlargement of hematoma were discussed.Results The operation time of subacute subdural heamato-ma was at 12.5-15.5d post injury and average was at 14.1d.All the three cases in our group showed that there was part of heamatoma delayed liquefaction, dexamethasone played a perfect nice role in one case.In another case, the subdural content drainaged uncompletely after operation led to recurrence.Conclusion It is a strong regular inflammation process leads acute subdural heamatoma developing into subacute subdural heamatoma.Maybe its mechanism is an allergic response：as an antigen delivers cell,neromembrane cells under dura-mater submit one kind of antigen released by blood clot liquefaction process to T lymphocyte which comes from capillary vessel in ner-omembrane , then the T lymphocyte become allergic.When the followed antigen released by delayed deliquescent blood clot contacts the allergic T lymphocyte , the inflammation process which like the four type allergic response occurs.

关 键 词：亚急性 硬膜下血肿 病理机制 变态反应 抗原递呈 

分 类 号：R651.1[医药卫生—外科学]