凝血功能障碍自发性颅内血肿的手术策略探讨  

Summary of treatment strategies enrolled in spontaneous intracranial hemorrhage concomitant with coagulation disorder

作　　者：钱腾达 钱春生 张斌 何云文 李益欢 李立新[2] QIAN Teng-da;QIAN Chun-sheng;ZHANG-bin(Department of Neurosurgery,Jintan People s Hospital Affiliated to Jiangsu University,Jintan 213200,China)

机构地区：[1]江苏大学附属金坛医院神经外科,金坛213200 [2]南京医科大学第一附属医院神经外科

出　　处：《临床神经外科杂志》2018年第6期428-431,共4页Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(81171147);江苏省"兴卫工程"医学重点人才基金(ZDRCA2016010);江苏省"六大人才高峰"基金;金坛科技计划项目(JT2014059)

摘　　要：目的探讨自发性颅内血肿伴有凝血功能障碍手术治疗的时机和方法。方法回顾性分析江苏大学附属金坛医院自2013年7月至2016年7月收治的20例凝血功能障碍自发性颅内血肿患者的临床资料。患者临床表现重,凝血酶原时间(prothrombin time,PT)、部分活化凝血酶原时间(activated partial thromboplastin time,APTT)以及血小板计数等有不同程度异常,其中轻度凝血功能异常16例,重度凝血异常4例;格拉斯哥昏迷量表(GCS)评分<8分,均急诊全麻下行开颅血肿清除术。结果轻度凝血功能异常患者,15例在术后未出现迟发性血肿并且恢复良好,1例处于植物生存状态;而重度凝血功能异常的患者,均出现迟发性血肿,3例处于植物生存状态,1例死亡。结论对于凝血功能异常的自发性颅内血肿患者,缩短手术时间,减少手术创伤,术中及时输成份血,可改善预后。Objective To explore surgical chance and tactics of the spontaneous intracranial hemorrhage(SICH)concomitant with coagulation disorder.Methods From July 2013 to July 2016,a total of 20 patients with SICH accompanying coagulation disorders were treated at Jintan People s Hospital affiliated to Jiangsu University were analyzed retrospectively.All patients underwent emergent decompressive cranioectomy.16 patients were characterized by mild coagulation disorder while 4 patients featured serious one according to PT,APTT and platelet count.Results Among patients present with mild abnormality in coagulation,15 didn t present delayed intracranial hemorrhage after surgery but 1 in vegetative state.On the contrary,1 died,and 3 in vegetative state,on serious condition.Conclusions Shortening operation duration,lessening injury to brain during surgery and timely transfusion of blood component are beneficial for the prognosis.

关 键 词：脑出血 凝血障碍 手术策略 输血 

分 类 号：R651.1[医药卫生—外科学]