33例高龄慢性硬膜下血肿的治疗体会  

Treatment experience on chronic subdural hematoma of 33 advanced age patients

作　　者：汪洋[1] 鲍得俊[1] 程传东[1] 汪大胜 魏祥品[1] 牛朝诗[1] 傅先明[1] 汪业汉[1] 

机构地区：[1]安徽省立医院神经外科,合肥230001

出　　处：《临床神经外科杂志》2017年第4期306-310,共5页Journal of Clinical Neurosurgery

基　　金：安徽省自然科学基金青年项目(1508085QH184)

摘　　要：目的探讨高龄患者慢性硬膜下血肿(CSDH)的治疗策略。方法回顾性分析安徽省立医院神经外科于2015年8月至2016年10月收治33例高龄(80岁以上)CSDH患者的临床资料、治疗方式及治疗效果。其中保守治疗2例,手术治疗31例,保守治疗口服阿托伐他汀,手术采用额颞部钻孔引流术。结果所有33例患者治疗后症状均获得不同程度改善,随访影像学检查较满意,无死亡病例。平均住院日为14.7 d,术后再出血4例,包括急性脑实质出血3例及急性硬膜下出血1例。此外,术后4例患者出现复发。结论高龄患者CSDH病情隐匿,诊断困难,病情变化快,术后并发症多。因此,术前评估、围手术期管理、必要的沟通及长期随访是成功治疗的关键。Objective To investigate therapeutic strategy of chronic subdural hematoma（ CSDH） of advanced age patients. Method Clinical data,therapy method and therapeutic efficacy of 33 advanced age patients（ over 80 years old） with CSDH who admitted to Department of Neurosurgery,Anhui Provincial Hospital Affiliated to Anhui Medical University from August 2015 to October 2016 were analysed retrospectively. 31 cases accepted frontal temporal drilling drainage and 2 accepted the oral atorvastatin in conservative therapy. Result Symptoms were improved in different degree,follow-up imaging examinations were satisfying and no death occurred among patients postoperatively. The average hospitalization days in this group were 14. 7 days. Unfortunately,acute subdural hematoma occurred in 1case and acuteparenchymal hemorrhage occurred in 3. Moreover,recurrence occurred in 4 cases.Conclusion Advanced age patients of CSDH present difficult diagnosis and rapid illness changes on account of the the hidden illness and severe complications. Furthermore,preoperative assessment,perioperative managemant,necessary communication and long-term follow up are the key to successful treatment.

关 键 词：高龄 慢性硬膜下血肿 钻孔冲洗引流术 再出血 复发 

分 类 号：R651.1[医药卫生—外科学]