慢性硬膜下血肿96例诊治分析

我科自1998—01～2009—10共收治CDSH病人96例,行血肿钻孔引流术,效果良好,现总结如下。     

慢性硬膜下血肿术后死亡的危险因素分析

目的探讨慢性硬膜下血肿钻孔引流术后发生死亡的危险因素,以降低患者术后死亡率。方法回顾性分析我院2003年1月1日至2012年12月31日在神经外科住院接受慢性硬膜下血肿钻孔引流术患者338例,其中男196例,女142例,年龄42~90岁,平均年龄(69.83±7.715)岁。收集所有患者术前、术中、术后临床资料,建立数据库,进行单因素及Logistic多因素分析影响慢性硬膜下血肿钻孔引流术术后死亡的危险因素。结果术后死亡14例(4.14%),9例患者死于肺部感染,1例患者死于脑实质出血,1例死于大面积脑栓塞,1例死于急性心肌梗死,1例死于急性肾功能衰竭,1例死于急性肺栓塞。单因素分析结果:死亡患者年龄(P=0.000)、采用全身麻醉手术比例(P=0.003)、既往慢性阻塞性肺病(COPD)发病率(P=0.001)高于生存组;术前Glasgow评分(P=0.000)低于生存组。Logistic回归多因素分析结果:患者高龄(P=0.002;比值比(OR)=1.311;95%可信区间(CI)=1.104-1.557)、Glasgow评分低(P=0.000;OR=0.172;95%CI=0.077-0.380)、既往COPD病史(P=0.020;OR=14.333;95%CI=1.529-134.325)是慢性硬膜下血肿(CSDH)术后死亡的危险因素。结论高龄、Glasgow评分低、既往COPD病史是CSDH术后死亡的危险因素。     

颅骨钻孔微创术引流治疗慢性硬膜下血肿50例报告

目的：应用颅骨钻孔置管冲洗引流术治疗慢性硬膜下血肿。方法：50例患者均采用颅骨钻孔插入硅胶引流管,冲洗引流血肿,术后根据引流液情况留管48－72h。结果：50例均获治愈出院,且跟踪无复发。结论：应用颅骨钻孔置管冲洗引流术治疗慢性硬膜下血肿疗效确切,适合各级医院开展。     

钻孔引流治疗慢性硬膜下血肿预后的影响因素分析

目的 研究影响钻孔引流治疗慢性硬膜下血肿(CSDH)预后的因素.方法 回顾性分析107例接受颅骨钻孔引流手术治疗的慢性硬膜下血肿患者的临床资料.分析患者的临床、影像学表现、手术效果.在术前及术后随访时采用改良Rankin量表(mRS)评分评价患者的神经功能状态.应用单因素分析和多因素Logistic回归分析从相关指标中...     

慢性硬膜下血肿（附122例分析）

慢性硬膜下血肿在临床上较为常见,治疗方法也较为简单。但目前治疗方法也多样,效果不定,缺乏循证后的科学治疗方法。本文通过对华山医院自1995年1月—2002年12月诊治的慢性硬膜下血肿的病例总结分析后,旨在结合文献归纳出治疗慢性硬膜下血肿(CSDH)的最佳方法。     

慢性硬膜下血肿钻孔引流术后复发原因分析

本研究回顾性分析我院2008-01—2011-12神经外科行钻孔引流术治疗的慢性硬膜下血肿患者的临床资料,以期为慢性硬膜下血肿患者钻孔引流术后复发的防治提供理论依据。     

慢性硬膜下血肿钻孔引流术后并发症临床分析

慢性硬膜下血肿（chronicsubduralhematoma,CSDH）为神经外科常见病,颅骨钻孔引流术（burr—holeirrigationanddrainage,BHID）是治疗CSDH常用且有效的方法,但术后并发症却不少见。现将我院1998年1月至2008年4月行BHID术后17例并发症进行回顾性分析,报道如下：     

慢性硬膜下血肿钻孔引流术后并发症临床分析

慢性硬膜下血肿(chronic subdural hematoma,CSDH)是位于硬脑膜与蛛网膜之间的常见疾病.好发于老年人,其起病隐袭,症状无明显特异性.但随着CT及MRI检查的逐步普及及应用,目前对慢性硬膜下血肿的诊断并不困难.     

高位颅骨钻孔引流术治疗慢性硬膜下血肿

目的 探讨高位颅骨钻孔置管冲洗引流术治疗慢性硬膜下血肿(CSDH) 的临床疗效。方法 回顾性分析279例CSDH患者经高位颅骨钻孔引流术治疗的临床资料。结果 279例患者血肿清除引流充分彻底,无明显并发症,平均置管引流时间为2.68 d,平均住院时间6.97 d,全部治愈。随访3~18个月,未见血肿复发及明显并发症,神经功能恢复良好。结论 高位颅骨钻孔置管冲洗引流术治疗CSDH为局麻下微创手术,病人体位舒适依从性好,双侧手术时无须变换体位,易于操作,引流管易放置无成角折屈,血肿冲洗清除充分,引流通畅,颅内压力,相对平稳、无明显手术并发症,疗效确切。     

慢性硬膜下血肿钻孔引流术后硬膜下脓肿形成的治疗

目的慢性硬膜下血肿术后并发硬膜下脓肿极为罕见,治疗方式多为再次置管引流,而选择开颅治疗极少,本文将对其开颅治疗进行讨论。方法回顾报道开颅手术治疗的两例慢性硬膜下血肿钻孔引流术后并发硬膜下脓肿的病例。结果两例病人预后均较好,未残留明显的神经系统受损体征。结论硬膜下脓肿术前的影像学评估十分重要,手术方式是选择再次钻孔引流还是开颅手术需依据术前影像学特征来合理选择,静脉应用敏感抗生素一定要足量、全程。     

慢性硬膜下血肿伴钙化1例报告

患者,男,49岁,因发作性意识丧失2d伴四肢抽搐1次入院。3年前曾有头部外伤史,未予诊治。查体：体温：36．5℃、脉搏：65次／min、呼吸：18次／min、血压：120／75mmHg,GCS评分：15分,神清,言语清晰,双侧瞳孔等大等圆,直径3mm,光反射敏感,四肢肌力均为Ⅴ级,肌张力正常,双侧巴宾斯基征（-）。头颅CT示：左侧额颞顶部囊性占位,周围伴蛋壳样钙化,中线明显右移,     

慢性硬膜下血肿的预后影响因素分析(附214例报告)

目的 探讨影响慢性硬膜下血肿(CSDH)预后的相关危险因素及其防治方法.方法 对2008年1月至2011年1月我院收治的214例CSDH患者的临床资料进行回顾性分析,收集患者的一般情况、临床症状、影像学表现、治疗方法、预后等资料进行统计学分析.结果 214例患者中康复者193例(89.72％),预后不良者22例(10.28％);男性188例(87.85％),女性26例(12.15％).单因素分析显示两组在性别,年龄,凝血功能,血肿位置,血肿量,入院时Markwalder’分级,头晕/头昏,双下肢乏力方面差异有显著性意义.多因素Logistic回归分析显示,影响CSDH预后的因素有性别,年龄,凝血功能,血肿位置,入院时Markwalder’分级.结论 影响CSDH预后的因素较复杂,根据患者的不同病情采取适当的治疗方法可降低血肿复发率.     

Idiopathic chronic subdural hematoma in the newborn: case report

Background Evidence of intrauterine development of chronic subdural hematoma (CSH) is extremely rare. A very limited number of cases with known and acceptable etiological explanation are reported. We were able to find out only four presented cases of intrauterine development of CSH without known etiology.Case report We present our case with a newborn baby with CSH without known etiology. Short literature review and possible etiological factors are observed.     

Three cases of chronic subdural hematoma with depressive state

The authors described 3 cases of chronic subdural hematoma (CSDH) with a depressive state. There were no abnormal findings from general and neurological examinations. Computed tomographic (CT) brain scans revealed sickle-shaped low density areas in the bilateral frontal lobes. Two of the 3 cases had not had episodes of head contusion, and it was not until the CT brain scanning that they were found to have CSDH. Evacuation of the hematomas was not considered suitable and the depressive state of these 2 cases was improved by antidepressants. The remaining case seemed to have become depressive because of failure in business. After the head contusion, his depressive state gradually became more severe. A neurosurgical operation was carried out to evacuate the hematoma. CSDH seemed to aggravate his depressive state. These 3 cases show that CSDH located in the bilateral frontal lobes may cause and/or influence affective disorder.     

神经内镜治疗分隔型慢性硬膜下血肿（附16例分析）

目的探讨神经内镜在治疗分隔型慢性硬膜下血肿中的应用价值。方法回顾性分析16例分隔型慢性硬膜下血肿病人的手术治疗方法。采用神经内镜在直视下先冲洗硬膜下血肿腔并对腔壁上的小出血点给予电凝止血,术野清晰后找到血肿腔分隔并将其造瘘,确保充分开放每个分隔,最后待冲洗液完全清亮后将血肿腔与正常硬膜下腔之间的隔膜充分打通,术后不放置引流。结果本组术后头痛症状均明显改善。术后2个月复查CT显示硬膜下腔完全恢复正常,随访3个月～8年,无复发。结论神经内镜治疗分隔型慢性硬膜下血肿是一种直观、便捷、安全、有效的微侵袭技术。     

Intrauterine chronic subdural hematoma

We discuss a newborn delivered by elective cesarean section who had macrocephaly with severe anemia. The anemia was corrected by exchange transfusion, and the infant, at first, appeared stable but manifested poor feeding and seizures. Transillumination of the skull was negative, although the anterior fontanel was tense. Computerized tomography demonstrated mild hydrocephalus and suggested subdural fluid. Bilateral subdural taps yielded fluid typical for chronic subdural hematoma. To our knowledge, this is the first documented case of intrauterine subdural hematoma developing in the absence of trauma. An analogy is made to the pathogenesis of subdural hematoma after rapid decompression of the ventricular system by shunting procedures for obstructive hydrocephalus.     

外伤性急性硬膜下血肿术后迟发脑内血肿27例报告

外伤性急性硬膜下血肿术后迟发脑内血肿在临床工作中时有发生,再出血使原有的脑损伤进一步加重,多发生于中老年患者,该病预后差,致残率高.我院自2006年以来外伤性急性硬膜下血肿435例,其中术后出现迟发脑内血肿共27例,现报告如下.     

Calcified chronic subdural hematoma mimicking calvarial mass: a case report

Head trauma is a frequent cause of mortality and morbidity in the pediatric population. Chronic subdural hematoma is the most common traumatic lesion in head injury. Chronic subdural hematomas are rare in children older than 2 years old; they are more frequent during adolescence. Calcified or ossified chronic subdural hematoma is a rare entity that usually presents as a space-occupying lesion over the cerebral convexity. Chronic calcified subdural hematomas are reported less than chronic subdural hematomas. In this article, we report a successfully treated patient with surgical removal case of calcified chronic subdural hematoma mimicking calvarial mass.