45例迟发性外伤性颅内血肿的临床诊治分析

目的探讨发生迟发性外伤性颅内血肿的原因,总结临床诊治的经验。方法回顾性分析迟发性外伤性颅内血肿临床病例45例。采用GOS预后评分对患者预后进行评估。结果迟发性外伤性颅内血肿和迟发型外伤性硬膜下血肿均发生在脑挫裂伤部位,迟发性外伤性硬膜外血肿均发生在颅骨骨折部位。按GOS分析,Ⅴ级（恢复良好）18例,Ⅵ级（中度伤残）10例,Ⅲ级（重度伤残）4例,Ⅱ级（植物生存）2例,Ⅰ级（死亡）1例。结论脑挫裂伤所致的血管损伤、血管自动调节功能失调是迟发性外伤性脑内血肿和迟发型外伤性硬膜下血肿形成的主要原因,颅骨骨折是迟发性外伤性硬膜外血肿形成的关键因素之一。早期发现、早期治疗迟发性外伤性颅内血肿是提高生存率和生存质量的关键。

Clinic diagnose and treatment of delayed traumatic intra cephalic hematoma on 45 cases

Objective The present study was carried out to investigate the etiopathogenisis of delayed traumatic intra cephalic hematoma （DTIH） and to summary the experiences of clinic diagnose and treatment. Methods 45 patients with DTIH were analyzed retrospectively. Glasgow outcome scale （GOS） was employed to evaluate the prognosis of these patients. Results Both delayed traumatic intracerebral hematoma and delayed traumatic subdural hematoma were originated in the brain tissues that were contused and lacerated. Nevertheless, all delayed traumatic extradural hematomas were come from the location of fracture of skull. The prognosis of all the 45 patients evaluated by GOS was 11 in grade Ⅰ （death no survival）, 2 in grade Ⅱ （persistent vegetative minimal responsiveness）, 4 in grade Ⅲ （severe disability conscious but disabled）, 10 in grade Ⅳ （ moderate disability disabled but independent）, and 18 in grade Ⅴ （ good recovery resumption of normal life despite minor deficits）, respectively. Conclusion It may play a key role in the process of delayed traumatic intracerebral or subdural hematoma that contusion and laceration of brain resulted in injury and disorder of automatic regulation function of blood vessel. The process of delayed traumatic extradural is owing to fracture of skull. Early discovery and treatment can help to improve the survival rate and prognosis for the patients with DTIH.