摘要
目的探讨重型颅脑损伤术中进展性颅内血肿的发病机制、临床特征、术中诊断及处置,以提高诊治水平。方法回顾性分析33例重型颅脑损伤术中进展性颅内血肿病例的临床资料,按术中探查清除血肿与术后CT发现并清除血肿分成两组,分析两组临床资料,比较两组疗效。结果按GOS标准,治疗6个月后评定治疗结果:术中探查组恢复良好10例,中残2例,重残2例,植物状态0例,死亡2例,良好率62.5%,病死率12.5%;术后CT组恢复良好4例,中残3例,重残2例,植物状态0例,死亡8例,良好率23.5%,病死率47.1%;两组比较术中探查组恢复良好率高、病死率低(P<0.05)。结论重型颅脑损伤术中进展性颅内血肿治疗的关键是在血肿造成不可逆性神经损害之前予以清除,依据其临床特征,术中及时作出定性、定位诊断,探查并清除血肿,能有效改善预后、降低病死率。
Objective To explore the pathogenesis,clinical feature,diagnosis during surgery and treatments of progressive intracranial hematoma during surgery for severe craniocerebral injury.Methods The clinical data of 33 patients with progressive intracranial hematoma during surgery for severe head injury were reviewed.33 patients were divided into two groups,group 1（n = 16） of patients whose progressive hematomas were found through exploration during surgery,group 2（n =17） of patients using CT scan after surgery.The both groups of progressive hematomas were evacuated after being found.The clinical data of the both groups were described and the therapeutic effects were analyzed.Results The patients were evaluated by Glasgow outcome scale（GOS） after 6 months.Group 1 patients,good recovery was found in 10 cases（62.5%）,moderate disability in 2 cases,severe disability in 2 cases,persistent vegetative state in 0 case,death in 2 cases（12.5%）.Of group 2 patients,good recovery was found in 4 cases（23.5%）,moderate disability in 3 cases,severe disability in 2 cases,persistent vegetative state in 0 case,death in 8 cases（47.1%）.The differences of proportions of good recovery and death in the both groups were significant（P〈0.05）.Conclusion The key point of the treatment of progressive intracranial hematoma during surgery for severe head injury is to evacuate the hematomas before they cause irreversible nervous lesion.The method of exploration during surgery and hematoma evacuation is more effective.
出处
《安徽医学》
2010年第8期930-932,共3页
Anhui Medical Journal
关键词
颅脑损伤
开颅手术
创伤性进展性颅内血肿
术中探查
Craniocerebral injury
Neurosurgery
Progressive traumatic intracranial hematoma
Exploration during surgery
