颅脑损伤21例开颅术后非手术区颅内血肿发生因素的探讨

目的探讨颅脑损伤开颅术后非手术区迟发性颅内血肿（DTICH）的危险因素。方法回顾分析21例颅脑损伤术后发生非手术区DTICH病例的临床资料。结果发生在颅脑损伤开颅手术后的非手术区颅内血肿占同期的7．5％，86％合并脑挫裂伤，58．6％合并颅骨骨折。首次术前外伤原发性颅内血肿量较大，平均56．4ml。69％术后去骨瓣减压和常规颅外引流。术后非手术区DTICH发生在72h内，其中13例为硬膜外血肿，5例为脑内血肿，3例为混合性的硬膜外和硬脑膜下血肿。21例术后DTICH再次手术治疗，恢复良好5例，中度残疾5例，重度残疾6例，死亡5例，病死率为23．8％。结论颅脑损伤开颅术后非手术区迟发性颅内血肿可能是脑挫裂伤及颅骨骨折的结果，手术导致的颅内压急剧下降是主要危险因素。

Investigation of the factors causing delayed traumatic intracranial hematoma in the non-operative area after craniotomy for craniocerebral trauma

Objective To investigate the risk factors causing delayed traumatic intracranlal hematoma （DTICH） in the non-operative area after craniotomy for cranioeercbral trauma. Methods The clinical data of 21 patients with DTICH in the non-operative area, which occurred after craniotomy for eraniocerebral trauma, were retrospectively analysed. Results The patients of this group constituted 7.5% of the patients undergoing eraniotomy for eranioeerebral trauma during the corresponding period. Eighty-six percent of the patients were accompanied with corebral contusion-laceration, 58. 6% with skull fracture. The blood volumes of the primarily traumatic intracranial hematombs occurring before the first operation were larger, averaging 56. 4 ml. A bony nap was removed from the skull for decompression and the conventional extraeranial drainage was performed in 69% of the patients after the operation. DTICH in the non-operative area, including chiefly extradural hematomas, cerebral contusion-laceration, mixed intracerebral and extradural hematomas, were discovered within 72 h after the operation. All the patients with postoperative DTICH underwent a second craniotomy to eliminate the hematoma. After the operation, 5 patients recovered well, 5 were disabled moderately and 6 seriously, 5 died （23. 8% ）. Conclusion Cerebral contuslon-laceration and skull fracture are the reason about DTICH in the non-operative area. The sharply decreased intracranial pressure resuiting from craniotomy for craniocercbral trauma is a major risk factor of DTICH occurring after the operation.