创伤性急性硬膜下血肿快速与非快速消散临床特征分析  

Analysis on clinical characteristics of rapid and non-rapid resolution of traumatic acute subdural hematoma

作　　者：庄泽锐[1] 郑灿坤 骆健明[1] 彭福玲 甘浩川 韩明对 刘斌[1] Zhuang Zerui;Zheng Cankun;Luo Jianming;Peng Fuling;Gan Haochuan;Han Mingdui;Liu Bin(Department of Neurosurgery,Second Affiliated Hospital of Shantou University Medical College,Shantou 515041,China;Department of Radiology,Second Affiliated Hospital of Shantou University Medical College,Shantou 515041,China;Department of Emergency,Second Affiliated Hospital of Shantou University Medical College,Shantou 515041,China)

机构地区：[1]汕头大学医学院第二附属医院神经外科,515041 [2]汕头大学医学院第二附属医院放射科,515041 [3]汕头大学医学院第二附属医院急诊科,515041

出　　处：《中华创伤杂志》2019年第12期1081-1086,共6页Chinese Journal of Trauma

基　　金：广东省医学科学技术研究基金(A2018361);广东省教育厅基金(2017KQNCX071)。

摘　　要：目的分析创伤性急性硬膜下血肿快速消散与非快速消散患者临床特征及临床意义。方法采用回顾性病例对照研究分析2011年1月—2018年5月汕头大学医学院第二附属医院收治的60例硬膜下血肿厚度≥5 mm、非急诊手术的急性硬膜下血肿患者临床资料,其中男37例,女33例;年龄18~80岁[(47.0±16.9)岁]。快速消散组27例,非快速消散组33例。比较两组患者入院时凝血功能[凝血酶原时间(PT)和国际标准化比值(INR)]、住院时间、格拉斯哥预后评分(GOS)及颅脑CT结果。结果快速消散组患者PT值和INR值分别为(11.9±2.1)s和1.1±0.2,非快速消散组分别为(10.8±1.0)s和1.0±0.1(P<0.05)。两组住院时间和GOS差异无统计学意义(P>0.05)。两组首次颅脑CT硬膜下血肿厚度分别为(8.2±2.3)mm和(7.3±1.8)mm(P>0.05)。复查CT结果快速消散组硬膜下血肿厚度为(2.7±1.9)mm,明显小于非快速消散组(6.6±2.1)mm(P<0.01)。快速消散组CT示急性硬膜下血肿与颅骨内板之间低密度带发生率为93%,明显高于非快速消散组的36%(P<0.01)。复查CT,快速消散组蛛网膜下腔出血(SAH)增多发生率为74%,明显高于非快速消散组的15%(P<0.01)。快速消散组急性硬膜下血肿转归为亚急性或慢性硬膜下血肿概率为4%,明显低于非快速消散组的18%(P<0.05)。结论急性创伤性硬膜下血肿患者出现凝血功能异常和颅脑CT提示低密度带是急性硬膜下血肿快速消散的两个重要指标。快速消散硬膜下血肿转变成亚急性或慢性硬膜下血肿概率更低,提示急性硬膜下血肿出现快速消散现象可能作为预测预后良好的指标之一。Objective To compare the clinical and imaging characteristics of traumatic acute subdural hematoma acute subdural hematoma with rapid resolution and those without rapid resolution.Methods A retrospective case-control analysis was conducted on the clinical data of 60 traumatic acute subdural hematoma patients with hematoma thickness≥5 mm admitted to Second Affiliated Hospital of Shantou University Medical College from January 2011 to May 2018.There were 37 males and 23 females,aged 18-80 years[(47.0±16.9)years].There were 27 patients in the rapid resolution group and 33 patients in the non-rapid resolution group.Coagulation function[prothrombin time(PT)and international normalized ratio(INR)]on admission,hospital stay,Glasgow outcome scale(GOS),and brain CT results were compared between the two groups.Results The PT and INR values in the rapid resolution group were(11.9±2.1)s and 1.1±0.2 respectively,while those in the non-rapid resolution group were(10.8±1.0)s and 1.0±0.1 respectively,with significant differences(P<0.05).There was no significant difference in hospital stay and GOS between the two groups(P>0.05).The thickness of subdural hematoma of the two groups in the first CT scanning was(8.2±2.3)mm and(7.3±1.8)mm,respectively,with no statistically significant difference(P>0.05).In the second CT scanning,the hematoma thickness in the rapid resolution group was significantly lower than that in the non-rapid resolution group[(2.7±1.9)mm vs.(6.6±2.1)mm](P<0.01).The incidence of low density zone between the hematoma and intracranial plate was statistically higher in rapid resolution group than that in non-rapid resolution group(93%vs.36%)(P<0.01).The incidence of subarachnoid hemorrhage(SAH)increase was significantly higher in rapid resolution group than that in non-rapid resolution group in the second CT scan(74%vs.15%)(P<0.01).The conversion rate of acute subdural hematoma to subacute or chronic subdural hematoma was 4%in the rapid resolution group,which was significantly lower than 18%in the non rapi

关 键 词：血肿 硬膜下 急性 体层摄像术 螺旋计算机 快速自然消散 

分 类 号：R65[医药卫生—外科学]