老年急性颅内血肿的演进特点与救治策略

目的探讨老年急性外伤性颅内血肿的演进特点及相应的救治策略。方法回顾性分析81例老年(60岁)急性外伤性颅内血肿的临床资料,根据入院时伤情轻重分入GCS3～5分组、GCS6～8分组和GCS9～13分组,并与90例入院时伤情程度相当的青年患者(35岁)作比较,统计分析组间不同的临床特点和治疗反应,包括血肿变化量、意识变化量、接受手术例数构成比、伤后住NICU(神经重症监护室)时间、并发症发生率、死亡率。结果GCS3～5分患者中,老年组与青年组在血肿量、意识水平变化量、死亡率方面无显著差异(P0.05),老年组接受手术例数比和伤后住NICU时间显著低于与青年组(P0.05),并发症发生例数比显著高于青年组(P0.05);GCS6～8分患者中,老年组与青年组在血肿量、意识水平变化量、接受手术例数比和伤后住NICU时间方面无显著差异(P0.05),老年组在并发症发生比、死亡率上显著高于青年组(P0.05);GCS9～13分患者中,老年组在入院时血肿量、伤后24小时血肿量、伤后48小时血肿量、血肿总变化量、意识变化量、接受手术例数比、伤后住NICU时间、并发症发生比、死亡率方面均高于青年组且有统计学意义(P0.05),老年组伤后48小时血肿量较24小时血肿量显著增加(P0.05)。结论GCS3～5分的老年患者,争夺救治时机是关键;GCS6～8分老年急性颅内血肿患者,提高应对并发症的防治能力是增加救治成功率的关键;GCS9～13分的老年患者,延长重症监护期、密切CT随访是救治成功的关键。

Clinical development and surgical strategy of acute intracranial hematoma in elderly patients

Objective To study the clinical development and surgical strategy of acute traumatic intracranial hematoma in the aged patients.Methods Eighty-one elderly patients（〉60 years）with acute traumatic intracranial hematomas and ninety young patients（〈35 years）with the same severity of brain injury were included in this retrospective study.All patients were classified into three groups as GCS 3 to 5,GCS 6 to 8 and GCS 9 to 13 according to severity at the time of admission.Clinical features and efficacy,including volume of hematoma at admission（Ha）,consciousness index（Ci）,ratio of surgical number（Nsr）,time of in ICU（TICU）,ratio of complication number（Ncr）,and mortality（M）,were analysed between groups.Results In the group of GCS 3 to 5,Ha,Ci and M were not significantly different between old patients and young patients（P〉0.05）.Nsr and TICU in elderly patients were significantly less than those in young patients（P〈0.05）,Ncr was more than that in young cases（P〈0.05）.In the group of GCS 6 to 8,no significant difference in parameters of Ha,Ci,Nsr,TICU was observed（P〉0.05）;Ncr and M in elderly cases were higher than those in young cases（P〈0.05）.In the group of GCS 9 to 13,almostly all clinical measurement,including Ha,volume of hematoma at 24 hours after admission（Ha24）,volume of hematoma at 48 hours after admission（Ha48）,index of hematoma（Hi）,Ci,Nsr,TICU,Ncr and M in group of aged were differed significantly from those in young patients group（P〈0.05）.In the group of elderly patients,Ha48 was higher compared with Ha24（P〈0.05）.Conclusion According to the characteristic of acute traumatic intracranial hematomas,the key of successful treatment is to gain opportunity of operation for patients with GCS 3 to 5,to prevent and control complication for patients with GSC 6 to 8,and to prolong the period of intensive care and promptly reexamine CT scan for patients with GSC 9 to 13.