脑中线区外伤性出血的治疗与预后

目的 探讨创伤性脑中线区出血的诊断、治疗和预后。方法 选择经CT证实脑中线区域有出血灶的重型颅脑损伤住院患12例。测算血肿体积和血肿距中线距离。急性期后隔日腰椎穿刺测CSF压力，计算平均CSF压力。采用Glasgow预后评定方法评估患预后。结果 预后不良4例(死亡1例、重残1例、中残2例)，恢复良好8例。平均腰椎穿刺CSF压力以及血肿体积在恢复良好和预后不良患组间无明显统计学差异，但预后不良组的血肿距中线距离则明显短于恢复良好组。结论 创伤性脑中线区域出血符合脑弥漫性轴索损伤(diffuse axonal injury，DAI)的病理改变，血肿距中线距离与患预后密切相关。

Treatment and prognosis of traumatic hemorrhage in brain midline areas

Objective To explore the diagnosis, treatment and prognosis of traumatic hemorrhage in midline brain areas.Methods Twelve inhospital patients with severe head injury were selected, all of which had been demonstrated hemorrhage in midline areas by CT. The hemorrhage volume and the distance between hematoma and brain midline were measured and calculated. During acute phase, lumbar puncture was performed each two days, and the average cerebrospinal fluid(CSF) pressure was calculated. The prognosis was made by Glasgow Outcome Scale method.Results Four cases showed bad prognosis (1 dead, 1 severe morbidity, and 2 mild morbidity). Eight patients recovered with better outcome. These two groups did not present statistically significant difference in average CSF pressure and hemorrhage volume while obvious difference in the distance between hematoma and brain midline could be seen.Conclusion The traumatic hemorrhage in midline areas conforms to the pathological changes of diffuse axonal injury (DAI). The distance between hematoma and brain midline is related to the prognosis of patients.