外伤性硬膜下积液的分型与临床特点

目的　探讨外伤性硬膜下积液的分型及其临床特点。　方法　对 192例资料完整的外伤性硬膜下积液患者 ,根据其动态CT观察及临床症状、体征进行分型 ,分别为消退型、稳定型、进展型和演变型 ,并对其临床特点进行总结、分析。　结果　消退型以青壮年多见 ,一般无明显颅内压增高 ,采取保守治疗 ,预后好 ;稳定型以老年人占多数 ,头痛、头晕、恶心、呕吐、精神异常 (欣快、淡漠、抑郁等 )、记忆力下降为主要表现 ,一般无与硬膜下积液相关的神经系统阳性体征 ,经非手术治疗 ,预后亦较好 ;进展型多为小儿患者 ,主要表现为进行性颅内压增高 ,可有轻度偏瘫、失语或精神异常等表现 ,多需外科治疗 ,可因合并脑实质损伤或术后并发症而有一定病死率 ;演变型呈发病年龄两极化 ,常发生在积液后 2 2～ 10 0d而且积液量少、保守治疗的病例中 ,合并的颅脑损伤常常很轻微 ,慢性颅内压增高 ,经外科治疗 ,预后良好。　结论　不同类型的外伤性硬膜下积液的发生机理、临床表现、治疗方法和预后各不相同 ,临床治疗策略也应不同。

Type and its clinical characteristics of traumatic subdural hydroma

Objective To explore the types and clinical characteristics of traumatic subdural hydroma (TSH). Method One hundred and ninety two cases of TSH were classified into four types: The types of resolution, steadiness, development and evolution on the basis of their clinical characteristics and dynamic observation of CT scanning. Results The patients in the resolution type often occurred in the prime of life. They had normal intracranial pressure and good prognoses using the conservative therapy. The mojorily of the elderly patients was in the steadiness type. Their main clinical manifestations included headache, dizziness, nausea, vomit, abnormal mentality and so on. Generally, there was no positive nervous systemic sign related to TSH The prognoses of patients with the steadiness type treated by conservative therapy were satisfactory The development type was common in the babies and children. This was mainly manifested as progressive increased intracranial pressure,mild hemiplegia, aphasia and abnormal mentality The patients with development type often needed surgical treatment and might die once in a while due to accompanying cerebral parenchymal damage or postoperative complications. The evolution type was characterized by the polarized age, chronic increased intracranial pressure, often happening between 22 and 100 days after TSH and in the cases of small hydromas treated conservatively and mild accompanying cerebral damage, which always have a good prognosis by the treatment of surgery. Conclusions The mechanism, clinical characteristics, treatment methods and prognoses varied with different types of TSH.