急性外伤性硬脑膜下血肿快速消散的病理、机制及相关因素探讨  

The pathology,mechanism and related factors for rapid dissipation of traumatic acute subdural hematoma

作　　者：杜海平 李刚[1] DU Hai-ping;LI Gang(Department of Neurosurgery,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院神经外科,济南250012

出　　处：《创伤外科杂志》2020年第4期264-266,共3页Journal of Traumatic Surgery

摘　　要：目的探讨急性外伤性硬脑膜下血肿(TASDH)快速消散的病理、机制,分析其相关因素,为临床治疗提供指导。方法回顾性分析2017年1月—2019年2月山东大学齐鲁医院神经外科TASDH患者12例,男性10例,女性2例;年龄15~51岁,平均35.8岁。观察患者入院时GCS评分、症状体征、头颅CT检查及诊断治疗情况,初步探讨血肿快速消散的机制。结果患者入院时平均GCS评分(11.7±2.2)分;平均血肿量18.2 mL。血肿呈断线样低高或等高混杂密度5例,较薄边缘呈锐利窄弧带样7例;中线移位7例,平均6.8mm,中线无移位5例;伴轻度脑挫裂伤2例,伴线性颅骨骨折4例;脑萎缩2例。伤后12h内消散3例,12~24h消散6例,24~72h消散3例;患者平均住院15.8d,出院3个月门诊随访,除1例偶有轻度头疼,近记忆力差的后遗症外,其余11例预后良好,无明显后遗症。结论部分TASDH患者经非手术治疗后血肿伤后12~72h消散,多数患者预后良好,可避免手术造成不必要的损伤。但在非手术治疗期间应根据病情变化行CT监测。Objective To investigate the pathology and mechanism for rapid dissipation of traumatic acute subdural hematoma(TASDH),and analyze its related factors,so as to provide guidance for clinical treatment.Methods Retrospective analysis of clinical data of 12 patients with TASDH after craniocerebral operation in the Department of Neurosurgery,Qilu Hospital of Shandong University from Jan.2017 to Feb.2019 was carried out.There were 12 males and 10 females.They were aged 15-51 years,with an average of 35.8 years.The GCS score,symptoms and signs,CT scan of the head and diagnosis and treatment of patients at the time of admission were observed,and the mechanism of rapid dissipation of hematoma was explored.Results At the time of admission,the average GCS score was(11.7±2.2)points;the average hematoma volume was 18.2 mL;as for hematoma morphology,5 cases had broken-line low or equal height mixed density,7 cases were thin,and the edges were sharp and narrow arc-like;7 cases had a midline displacement with an average displacement of 6.8 mm,and 5 cases had no midline displacement.Complicated injuries:2 cases of mild cerebral contusion,4 cases of linear skull fracture,and 2 cases of brain atrophy.Hematoma dissipation time:3 cases dissipated within 12 hours after injury,6 cases dissipated within 12 to 24 hours,and 3 cases dissipated from 24 to 72 hours after injury.The patients were hospitalized for an average of 15.8 days,followed by a 3-month outpatient follow-up.Except for sequelae of head-ache and near bad memory in 1 case,the remaining 11 patients had good prognosis without obvious sequelae.Conclusion After conservative treatment,some patients with TASDH will dissipate the hematoma between 12 and 72 hours after injury.Most patients have good prognosis and can avoid unnecessary injury caused by surgery.However,during conservative treatment,CT monitoring should be performed based on changes in the condition.

关 键 词：颅脑损伤 硬脑膜下血肿 快速消散 机制 

分 类 号：R651.15[医药卫生—外科学]