高龄慢性硬膜下血肿合并急性脑内出血1例  

One case of chronic subdural hematoma in the elderly complicated with acute intracerebral hemorrhage

作　　者：王鹏[1] 殷尚炯[1] 王志明[1] 程月飞[1] 刘丽娜[1] WANG Peng;YIN Shang-jiong;WANG Zhi-ming;CHENG Yue-fei;LIU Li-na(Department of Neurosurgery,The Hospital of 81st Group Army PLA,Zhangjiakou 075000,China)

机构地区：[1]中国人民解放军陆军第八十一集团军医院神经外科,河北张家口075000

出　　处：《中国临床神经外科杂志》2024年第11期700-701,704,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：慢性硬膜下血肿(CSDH)是神经外科常见疾病。临床上,高龄CSDH合并急性多发性脑实质出血,如何处理比较棘手。本文报道1例高龄CSDH,为80岁男性,因突发昏迷8 h入院。部CT示右额颞顶枕CSDH,血肿量约100 ml;合并右侧颞叶-基底节出血(约35 ml)及少量双侧顶叶出血。因高龄、基础病多,无法接受开颅手术,遂先行颅内压监护下CSDH穿刺引流术。次日复查头部CT示硬膜下血肿基本消失,脑组织复位良好,颅内压在正常范围,拔除穿刺针。2 d后颅内压逐渐升高,遂行颞叶-基底节血肿穿刺引流术。术后行气管切开术,病人意识逐步恢复至朦胧状态,出院时遗留肢体偏瘫。随访3个月,意识清楚,遗留轻偏瘫,生活不能完全自理。总之,高龄CSDH,应结合病人具体情况,谨慎选择治疗方法。Chronic subdural hematoma(CSDH)is a common disease in neurosurgery.Clinically,the treatment of CSDH in elderly patients combined with acute multiple parenchymal hemorrhages is rather perplexing.This paper reports a case of CSDH in an 80-year-old male who was admitted to the hospital due to sudden coma for 8 hours.Head CT showed right frontotemporoparietaloccipital CSDH with a volume of approximately 100 ml;it was complicated with right temporal lobe-basal ganglia hemorrhage(about 35 ml)and a small amount of bilateral parietal hemorrhage.Due to advanced age and multiple underlying diseases,the patient was unable to undergo craniotomy.Therefore,a CSDH puncture and drainage procedure was performed under intracranial pressure monitoring.The next day,a follow-up head CT revealed that the subdural hematoma had almost vanished,the brain tissue was well repositioned,and the intracranial pressure was within the normal range.The puncture needle was removed.Two days later,the intracranial pressure gradually increased,and a puncture and drainage procedure for the temporal lobe-basal ganglia hematoma was carried out.A tracheotomy was performed after the operation,and the patient's consciousness gradually recovered to a drowsy state.At discharge,the patient had hemiparesis.After a 3-month follow-up,the patient was conscious with mild hemiparesis and was unable to take care of himself completely.In conclusion,for elderly patients with CSDH,the treatment method should be carefully selected based on the specific conditions of the patient.

关 键 词：慢性硬膜下血肿 高龄 脑内出血 穿刺引流术 

分 类 号：R651.15[医药卫生—外科学] R651.11[医药卫生—临床医学]