控制慢性硬膜下血肿扩大的时间节点探讨  

Explore of the Treating Stage of Medicaments Controlling Chronic Subdural Hematoma Expansion

作　　者：陶志强[1] 高国一[2] 丁胜鸿[1] 林盈盈[2] 冯军峰[2] 李剑伟[1] 江基尧[2] 

机构地区：[1]义乌市中心医院神经外科,322000 [2]上海交通大学附属仁济医院神经外科,200127

出　　处：《医学研究杂志》2016年第3期150-153,160,共5页Journal of Medical Research

摘　　要：目的探讨药物抑制慢性硬膜下血肿(CSDH)扩大的时间节点。方法选择合适的CSDH患者进行药物干预,同时随访头外伤后硬膜下积液(SDE)患者,观察SDE向CSDH演变的时间过程、出血影响因子和干预效果。结果 16例患者21个CSDH病灶,1例治疗失败,15例治疗成功;6例无症状CSDH无任何处理自然吸收;SDE向CSDH演变的密度缓慢升高期使用双氯芬酸使血肿增大1例;双侧病损患者两侧进展大多不同步。结论 CSDH有自愈性。从SDE出血向CSDH演变时,外包膜出血负反馈机制迟钝或障碍是引起症状性CSDH的重要原因。密度缓慢升高期和明显出血期尚无体积膨大、出现症状之前可能是药物抑制血肿扩大的时间节点。Objective To explore the treating stage of medicaments controlling chronic subdural hematoma （CSDH） expansion. Methods Applicable cases was chosen for medicaments treating. Follow-up head injury cases whom companied with subdural effusion （SDE）. During the procedure of SDE developing into CSDH, the bleeding influence factors and medicaments intervening effects was analyzed. Results In the 16 cases bearing with 21 CSDH lesions, 15 cases was treated successfully and only one case failed. Six asymptomatic lesions absorbed spontaneously without any treatments. CSDH expansion was found in one case who was taking diclofenac sodium during the density slow elevated stage. Most lesions in both side developed out of sync. Conclusion CSDHs can self-healing. During the bleeding stage of SDE evolving into CSDH, the bleeding negative feedback delayed or obstructed in out neo-membrane is the reason of CSDH expansion arousing symptoms. In the developing course, the density elevated slow stage and the obvious bleeding stage without symptoms and size increase is the occasion of medicaments controlling CSDH expansion.

关 键 词：硬膜下积液 慢性硬膜下血肿 分期 药物治疗 机制 

分 类 号：R651.1[医药卫生—外科学]