急性颅脑损伤术后继发对侧迟发性血肿的治疗

目的　探讨如何及时发现颅内迟发性血肿并及时治疗 ,提高疗效 ,改善患者预后。方法　分析我院近 8年来急性外伤性颅内血肿清除术后发生的对侧迟发性颅内血肿 35例病例 ,包括致伤原因、致伤部位与迟发血肿部位 ,原发血肿清除与迟发血肿形成的关系、时间 ,临床特点与治疗效果。结果　本组 35例对侧迟发性颅内血肿病例中 ,硬膜外血肿 2 1例 ,硬膜下血肿 6例 ,脑内血肿 6例 ,多发性血肿 2例。预后良好 18例 ,重残 5例 ,植物生存 2例 ,死亡 11例。手术死亡率为 2 5 0 %。结论　急性颅脑外伤血肿清除术后继发对侧迟发性血肿形成有可预见性因素和明显临床特点 ,对首次CT提示颅内血肿伴脑挫裂伤或小出血灶、术后病情有变化者 ,应考虑有迟发性颅内血肿形成 ,宜动态复查CT ,加强观察和监护 ,必要时手术探查 ,早诊早治 ,以改善预后

Clinical Analysis on the Incidence of Delayed Hematoma after Removal of Acute Intracranial Hematoma

Objective To investigate how to diagnose and treat the delayed traumatic intracranial hematoma (DTICH) in time to improve the curative effect. Methods The materials of 35 cases postoperative delayed intracranial hematoma after removal of acute intracranial were reviewed to the injured caused, injured parts, the parts and time DTICH in the caput, the relation between the removal of primary intracranial hematoma and the forming of the delayed intracranial hematoma, the clinical characteristics and its curative effect in our hospital in the past 8 years. Results In the 35 cases of postoperative delayed intracranial hematoma after removal of acute intracranial hematoma, 21 were extradural hematoma, 6 subdural, 6 intracerebral and two poly-hematoma. And 18 cases aquired nice rehabitalitation. 5 cases were cripple badly, 2 cases survived only as vegetables and 2 cases were dead. The mortality in the surgery was 25.0%. Conclusion There were adumbrative occurent clues and obvious clinical characteristics of the delayed traumatic intracranial hematoma after the removal of acute traumatic intracranial hematoma. DTICH should be considered in first image of CT scan and especially in patients whose postoperative conditions were deteriorating. Application for a CT series in theses patients was necessary. Observation and custodial of the patient's condition should be reinforced. The secondary exploration must be made to improve the prognosis in the essential time.