急性硬膜下血肿保守治疗的一个前瞻性研究

目的调查急性硬膜下血肿（ASDH）在亚急性和慢性硬膜下血肿（CSDH）形成中的卷入情况及不同转归病人的临床和CT特点。方法以收治本科未经急性期手术的ASDH病人为对象，记录来院时病人的症状、体征和CT变化参数，并CT复查（24h内密集实施）直至一个核定的转归。随访6个月。结果38例患者发生6种转归：再出血ASDH明显增大或脑内血肿增大手术2例，亚急性化手术6例，血肿区脑脊液渗入4例，血肿液化后逐渐吸收4例，数小时至数天内消散21例，慢性化1例。血肿自然消散的时间为2．5h-6d，约66．7％的病例1d内消散。较厚的血肿容易亚急性化，亚急性化手术多在伤后8～18d，平均第13天。血肿液化后部分病例体积稍增大但可以不手术，吸收时间在第13～45天，平均27．7d。慢性化1例，在伤后2．5个月时手术。4例血肿区脑脊液渗入者中，3例CT证实为慢性硬膜下血肿，另1例临床也支持。6个月时随访，2例死亡可能与CSDH相关，没有发现其他与原创疾病相关的手术或死亡病例。结论急性硬膜下血肿是亚急硬膜下血肿的来源，但它与慢性硬膜下血肿可能无直接关系。

A prospective study of acute subdural haematomas in patients with conservative management

Objective To investigate the involving condition of acute subdural haematomas(ASDH) in the forming of subacute or chronic subdural haematomas(CSDH),and study the clinical and CT features of patients with various prognosis.Methods The object was the patients with ASDH managed conservatively who admited at our department.Recorded their symptoms,signs and CT change parameters.CT examing repeated(do it frequently within 24 hours) until a certain outcomes and 6-month follow-up.Results There were six kinds of outcome in 38 cases:rebleeding led to ASDH enlargement or haematoma in brain tissue increased obviously and that were operated in two cases;six cases were operated due to subacute subdural haematomas(sASDH);cerebrospinal fluid(CSF) effused into the subdural caves of haematomas in four cases;four haematomas were liquefied and then absorbed gradually;21 were liquidated within several hours or several day;one case developed into CSDH.The time of haematoma liquidation was for 2.5 hours-6 day naturally.About 66.7% cases,their haematomas were cleared away in one day.Thick haematomas developed into sASDH more easily.SASDH often be operated at 8-18 days after wound.The days in average is 13 days.The size of some liquefied ASDH may increase slightly but can be nonoperative.The date of finishing absorption was at the 13-45th day after wound,in average 27.7 days.One case of CSDH was operated at 2.5 months after wound.In four cases whom CSF effused into ASDH caves,three cases was confirmed for CSDH by CT,another was also considered becoming CSDH clinically.Two cases died caused by CSDH at 6-month follow-up.We didn't find any other died or operated cases who was relative to ASDH.Conclusion ASDH is the source of sASDH,but CSDH may have no relationship with ASDH directly.