颅脑损伤术后对侧迟发性颅内血肿83例分析

目的探讨外颅脑损伤术后对侧迟发性颅内血肿的预防、诊断及治疗措施,降低颅脑损伤术后对侧颅内血肿的发生率、提高及时诊出率、增加抢救与治疗成功率,改善患者预后。方法对神经外科2005年7月22日—2013年8月6日共计83例颅脑损伤术后发生对侧迟发性颅内血肿患者的病因、临床症状、诊断、治疗及预后结合相关文献进行回顾性临床分析。结果 83例患者均通过电话、短信、网络等方式进行随访,所有患者都随访6个月。6个月后,按GOS评分,恢复良好,生活自理者47例,轻度残疾,生活基本自理者16例,重度残疾,生活需要照料者9例,植物生存,仅有最小反应者5例,死亡3例,失访3例。结论颅脑损伤术后对侧迟发性颅内血肿在临床上并非罕见,约占颅脑损伤手术患者的10%,该疾病病情进展迅速,迟发性血肿会对患者造成二次打击并可导致术后顽固性颅高压,使病情进行性加重并导致严重后果;部分患者病情隐蔽,不易被及时发现而贻误最佳抢救时机,一旦病情恶化,可延长患者恢复期并使患者预后变差甚至导致患者死亡,合理的初次手术方案,及时合理的影像学检查以早期发现,及时有效的处理是降低颅脑损伤术后对侧迟发性颅内血肿的发生率及改善患者预后、提高生存质量的关键。

83 Cases of delayed post-operative contralateral intracranial hematoma in patients with craniocerebral injury

Objective To investigate the prevention,diagnosis and treatment of delayed post-operative contralateral intracranial hematoma in patients with craniocerebral injury,improve the diagnosis,a rescue and prognosis. Methods The etiology,clinical symptoms,diagnosis,treatment and prognosis in 83 cases delayed post-operative contralateral intracranial hematoma were reviewed retrospectively. Results After a follow up of 6 months,Glasgow Outcome Scale（GOS） was used to assess the recovery of patients. 47 cases were with good recovery and normal living ability,16 cases with mild disability and basic living ability,9 cases with severe disability and need of care in life,5 cases were vegetable with only minimal response,3 cases died and 3 cases lost to follow-up. Conclusion The delayed post-operative contralateral intracranial hematoma progress quickly,the delayed treatment will prolong the recovery period,lead to a poor prognosis even death of patients. The early diagnosis by timely imaging examination,reasonable first operation and effective treatment can decrease the incidence of post-operative contralateral hematoma,improve the prognosis and quality of life of patients.