老年人迟发性外伤性颅内血肿的早期诊治

目的探讨老年人迟发性外伤性颅内血肿(DTIH)的早期诊疗方案。方法对老年人DTIH 171例的临床资料进行回顾性分析。结果原发性昏迷125例,占73.1%;意识障碍一度好转又恶化49例,占28.7%;意识障碍进行性加重109例,占63.7%。首次头颅CT征像:未见异常9例,颅骨骨折15例;硬膜外血肿9例;硬膜外血肿伴对冲部脑挫裂伤4例;脑挫裂伤伴蛛网膜下腔出血83例,占48.5%;硬膜外血肿伴脑挫裂伤11例;蛛网膜下腔出血64例,占37.4%;上述征像均伴有不同程度脑受压。复查头颅CT征象:DTIH发生于首次CT无异常处25例,硬膜外6例;脑挫裂伤和/或蛛网膜下腔出血162例占94.7%;血肿量20~130 mL,50 mL以上87例,占50.9%。手术治疗122例,恢复良好83例,中残7例,重残4例,植物状态2例,死亡26例;非手术治疗49例,恢复良好36例,死亡8例,自动出院5例。结论掌握老年人的病理生理特点及其DTIH的临床表现与头颅CT征像等特征,严密观察意识演变等病情变化,头颅CT追踪动态观察颅脑损伤病灶变化,是早期诊断的关键。血肿占位效应及意识状态是选择手术或非手术治疗的主要指标。

Diagnosis and treatment of elderly with delayed traumatic intracranial hematoma at earliest period

Objective It is to approach the diagnosis and treatment of elderly with delayed traumatic intracranial hematoma(DTIH) at earliest period.Methods The clinical data of 171 elderly with DTIH was analyzed retrospectively.Results Primary coma was 125 cases for 73.1%.Consciousness disorders transient better and worse was 49 cases for 28.7%.Consciousness disorders progressive exacerbation was 109 cases for 63.7%.The first head CT signs: normal was 9 cases,skull fractures was 15 cases,epidural hematoma was 9 cases,...