急性硬膜下血肿预后因素分析

目的 探讨CT征象、GCS评分、瞳孔变化、手术时机、血压、年龄、血糖、血白细胞计数和并发症对96例急性硬膜下血肿手术患者预后因素的影响。方法 对我科96例急性硬膜下血肿手术患者预后影响因素进行回顾性分析。结果 按COS标准，恢复良好46．9％，中度残疾9．4％，重度残疾6．3％，持续性植物生存5．2％，死亡32．2％。结论 CT征象、GCS评分、瞳孔变化、手术时机、血压、年龄、血糖、血白细胞和并发症是评价急性硬膜下血肿预后的可靠指标。及时、正确清除血肿，标准去骨瓣减压，维持正常血压，控制血糖和防治并发症，能有效改善急性硬膜下血肿患者预后，也是降低患者死残率的最有效措施。     

钻颅注氧置换治疗慢性硬膜下血肿

目的观察钻颅注氧置换治疗慢性硬膜下血肿的临床疗效.方法30例患者局麻后,用颅锥穿颅骨内板,穿刺置入双腔管,先用生理盐水进行血肿冲洗,再注入氧气(每次20m1),使血肿腔内残留液体流出,如此反复操作,直至无液体换出为止.结果术后1周内全部病例的临床症状全部或绝大部分消失.术后2个月后CT复查结果全部病例血气体均基本吸收,无1例复发.随访半年,无1例复发及并发症发生.结论钻颅注氧置换治疗慢性硬膜下血肿是一种操作简便、创伤小、安全可靠、疗效显著确切、适应症宽、所需器械少、易于推广的术式.     

76例产后阴道血肿的临床分析

目的 :探讨减少产后阴道血肿发生的方法。方法 :应用回顾性方法对 76例产后阴道血肿临床资料进行分析。结果 :76例患者急产占 2 7 6 3% ,第二产程延长占 4 6 0 5 % ,血肿发生在会阴左侧切口处及左侧阴道壁占 6 9 73% ,血肿发生时间在产后 2h内占 84 2 1%。结论 :产后阴道血肿的发生与产科质量密切相关     

急性脑肿胀去大骨瓣减压术后迟发性血肿

目的探讨外伤后急性脑肿胀去大骨瓣减压术后迟发性血肿的发病机制及临床表现，以提高该类病人的手术疗效。方法回顾性分析28例急性脑肿胀去大骨瓣减压术后迟发性颅内血肿病人的临床表现。结果外伤后急性脑肿胀去大骨瓣术后迟发性血肿的发生率为19．56％，术区继发硬膜外血肿10．87％。死亡率为32．12％。结论急性脑肿胀去大骨瓣术后迟发性血肿的发生率较高，多见于脑肿胀缓解病例，对术中出现的急性脑膨出和术后病情恶化应考虑到迟发性血肿的可能，早期的诊断是提高疗效的关键。     

急性颅内血肿清除后继发对侧迟发性血肿

目的：急性外伤性颅内血肿清除的术中及术后，如及时发现对侧迟发性血肿并治疗可提高疗效。方法：在术中发生急性脑肿胀时应在对侧钻颅探查或术后病人恶化时行ＣＴ检查。结果：治疗３０例对侧迟发血肿病人其中１０例死亡，手术死亡率为３３．３％。结论：在清除急性外伤性颅内血肿时发生急性脑肿胀或术后病情恶化应想到对侧可能是迟发性血肿形成，宜尽早钻颅探查或复查ＣＴ，早诊早治可改善预后。     

颅骨钻单孔引流治疗慢性硬膜下血肿108例分析

目的：探讨颅骨钻单孔用特制血肿腔冲洗引流管冲洗引流治疗慢性硬膜下血肿的效果。方法：对108例病人进行回颐性分析。结果：治愈106例，随访1～6年无复发。死亡2例，死亡率1．85％。结论：应用颅骨钻单孔，置特制血肿腔冲洗引流管治疗慢性硬膜下血肿，减化了传统钻双孔的手术程序且效果满意。     

The Kernohan-Woltman Notch Phenomenon : A Systematic Review of Clinical and Radiologic Presentation,Surgical Management,and Functional Prognosis

The Kernohan-Woltman notch phenomenon (KWNP) refers to an intracranial lesion causing massive side-to-side mass effect which leads to compression of the contralateral cerebral peduncle against the free edge of the cerebellar tentorium. Diagnosis is based on “paradoxical” motor deficit ipsilateral to the lesion associated with radiologic evidence of damage to the contralateral cerebral peduncle. To date, there is scarce evidence regarding KWNP associated neuroimaging patterns and motor function prognostic factors. A systematic review was conducted on Medline database from inception to July 2021 looking for English-language articles concerning KWNP, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research yielded 45 articles for a total of 51 patients. The mean age was 40.7 years-old and the male/female sex ratio was 2/1. 63% of the patients (32/51) suffered from head trauma with a majority of acute subdural hematomas (57%, 29/51). 57% (29/51) of the patients were in the coma upon admission and 47% (24/51) presented pupil anomalies. KWNP presented the neuroimaging features of compression ischemic stroke located in the contralateral cerebral peduncle, with edema in the surrounding structures and sometimes compression stroke of the cerebral arteries passing nearby. 45% of the patients (23/51) presented a good motor functional outcome; nevertheless, no predisposing factor was identified. A Glasgow coma scale (GCS) of more than 3 showed a trend (p=0.1065) toward a better motor functional outcome. The KWNP is a regional compression syndrome oftentimes caused by sudden and massive uncal herniation and leading to contralateral cerebral peduncle ischemia. Even though patients suffering from KWNP usually present a good overall recovery, patients with a GCS of 3 may present a worse motor functional outcome. In order to better understand this syndrome, future studies will have to focus on more personalized criteria such as individual variation of tentorial notch width.     

健康教育路径在亚急性硬膜下出血微创血肿清除术患者中的应用

目的探讨健康教育临床路径对亚急性硬膜下出血微创血肿清除术围手术期患者的作用。方法将50例患者随机分为观察组和对照组,每组各25例。对照组采用常规进行健康教育方式,观察组则采用临床路径图的健康教育方式。结果两组患者疾病相关知识掌握情况及满意度的差异均有统计学意义(均P<0.01),其中观察组疾病相关知识的掌握率和满意度均高于对照组。结论应用健康教育路径,有利于患者以最快的速度,最短的时间完成各项术前准备及术后护理,改善了护患关系,提高了病人满意度和康复质量。