CAJ | 학술논문

目的探讨长期口服阿司匹林合并颅脑损伤患者的临床特点及治疗方法. 方法回顾性分析2010年1月-2012年6月收治的长期口服阿司匹林合并颅脑损伤患者24例.其中男15例,女9例；年龄52～78岁,平均63.5岁.致伤原因:交通伤18例,坠落伤4例,打击伤2例.入院时GCS 13～ 15分6例,10～ 12分10例,＜8分8例.保守治疗6例,钻孔碎吸引流9例,小骨窗颅内血肿清除6例,去骨瓣减压加血肿清除3例.外伤后随访3个月,采用格拉斯哥预后评分(Clasgow outcome score,GOS)评价患者预后:Ⅴ级为恢复良好；Ⅳ级为轻度残疾；Ⅲ级为重度残疾；Ⅱ级为植物状态生存；Ⅰ级为死亡.其中Ⅴ级和Ⅳ级为效果良好. 结果效果良好15例(62.5％),效果不良9例(37.5％). 结论长期服用阿司匹林合并颅脑损伤患者具有易发生迟发性进展性脑出血、脑内多灶部位出血、术后再出血概率高等特点,应停服阿司匹林,给予促凝药物、血小板或新鲜血浆治疗,病情危重应手术治疗,轻者尽可能非手术治疗.
목적 탐토장기구복아사필림합병로뇌손상환자적림상특점급치료방법. 방법 회고성분석2010년1월-2012년6월수치적장기구복아사필림합병로뇌손상환자24례.기중남15례,녀9례；년령52～78세,평균63.5세.치상원인:교통상18례,추락상4례,타격상2례.입원시GCS 13～ 15분6례,10～ 12분10례,＜8분8례.보수치료6례,찬공쇄흡인류9례,소골창로내혈종청제6례,거골판감압가혈종청제3례.외상후수방3개월,채용격랍사가예후평분(Clasgow outcome score,GOS)평개환자예후:Ⅴ급위회복량호；Ⅳ급위경도잔질；Ⅲ급위중도잔질；Ⅱ급위식물상태생존；Ⅰ급위사망.기중Ⅴ급화Ⅳ급위효과량호. 결과 효과량호15례(62.5％),효과불량9례(37.5％). 결론 장기복용아사필림합병로뇌손상환자구유역발생지발성진전성뇌출혈、뇌내다조부위출혈、술후재출혈개솔고등특점,응정복아사필림,급여촉응약물、혈소판혹신선혈장치료,병정위중응수술치료,경자진가능비수술치료.
Objective To investigate the clinical characteristics and treatments of patients with long-term oral aspirin treatment combined with craniocerebral injury.Methods A retrospective analysis was made on 24 cases admitted for long-term oral aspirin treatment combined with craniocerebral injury from January 2010 to June 2012.There were 15 males and 9 females at age of 52-78 years (mean,63.5years).Injuries were caused by a traffic accident in 18 cases,a high fall in four and a blow in two.GCS on admission was 13-15 points in six cases,10-12 points in 10 cases and ＜ 8 points in eight cases.Six cases had conventional treatment,nine puncture drainage,six intracerebral hematoma evacuation by small craniotomy and three hematoma evacuation by large craniotomy.Results The patients were followed up for three months.Glasgow outcome score (GOS) was used to assess the prognosis in five categories,i.e.,grade Ⅴ (good recovery),grade Ⅳ (low disability),grade Ⅲ (severe disability),grade Ⅱ (vegetative state) and grade Ⅰ (death).Besides,grades Ⅴ and Ⅳ GOS represented a good outcome.Of these patients 15 (62.5％) had good results and nine (37.5 ％) undesirable results.Conclusions Patients with long-term oral aspirin administration combined with craniocerebral injury are characterized by high incidence of delayed and progressive cerebral hemorrhage,multi-focus intracerebral hemorrhage and postoperative rehemorrhagia.Therefore,aspirin therapy should be discontinued.Instead,enough blood coagulation accelerator,platelet and fresh plasma should be given.An operation is necessary for the patients with critically severe conditions but is not advisable for the patients with milder conditions.