CAJ | 학술논문

目的探讨重型复合性硬膜下血肿的临床特点、手术治疗方法及预后. 方法回顾性收集江门市新会区人民医院神经外科自2010年3月至2013年3月收治的96例重型复合性硬膜下血肿患者的临床资料,分析患者的伤情表现、头颅CT特点、手术情况、术后颅内压改变等,以及与其预后的关系. 结果伤后3～6个月GOS评分评定为死亡16例,植物生存6例,重残13例,中残24例,恢复良好37例.96例患者中,特急性血肿的病死率为20.8％(11/53),急性血肿的病死率为15.6％(5/32),亚急性血肿11例无一死亡;GCS评分3分的死亡率为100％(6/6),4分的死亡率为60％(6/10),5分的死亡率为10％(2/20),6分的死亡率为4.5％(1/22),7分的死亡率为4.8％(1/21),8分者17例无一例死亡;双侧瞳孔散大者死亡率为53.3％(8/15),单侧瞳孔散大者死亡率为14.8％(8/54),无瞳孔散大者27例无一例死亡;术后颅内压＜30 mmHg者20例无一例死亡,31～35mmHg者死亡率为57.1％(4/7),＞35 mmHg者8例全部死亡;死亡病例的CT中线移位均超过10mm. 结论在重型复合性硬膜下血肿患者中,病情进展快、GCS评分低、双侧瞳孔散大、中线移位超过10mm、术后颅内压持续＞30mmHg提示死亡几率高、预后不良.
목적 탐토중형복합성경막하혈종적림상특점、수술치료방법급예후. 방법 회고성수집강문시신회구인민의원신경외과자2010년3월지2013년3월수치적96례중형복합성경막하혈종환자적림상자료,분석환자적상정표현、두로CT특점、수술정황、술후로내압개변등,이급여기예후적관계. 결과 상후3～6개월GOS평분평정위사망16례,식물생존6례,중잔13례,중잔24례,회복량호37례.96례환자중,특급성혈종적병사솔위20.8％(11/53),급성혈종적병사솔위15.6％(5/32),아급성혈종11례무일사망;GCS평분3분적사망솔위100％(6/6),4분적사망솔위60％(6/10),5분적사망솔위10％(2/20),6분적사망솔위4.5％(1/22),7분적사망솔위4.8％(1/21),8분자17례무일례사망;쌍측동공산대자사망솔위53.3％(8/15),단측동공산대자사망솔위14.8％(8/54),무동공산대자27례무일례사망;술후로내압＜30 mmHg자20례무일례사망,31～35mmHg자사망솔위57.1％(4/7),＞35 mmHg자8례전부사망;사망병례적CT중선이위균초과10mm. 결론 재중형복합성경막하혈종환자중,병정진전쾌、GCS평분저、쌍측동공산대、중선이위초과10mm、술후로내압지속＞30mmHg제시사망궤솔고、예후불량.
Objective To investigate the clinical features,surgical treatment methods and prognostic evaluations of severe and complex subdural hematoma.Methods A retrospective analysis of clinical data of 96 patients with severe and complex subdural hematoma,admitted to our hospital from March 2010 to March 2013,was performed; the relationships of patient's injuries,CT characteristics,surgical treatments,intracranial pressure changes after surgery with prognosis were analyzed.Results All patients were underwent a standard large trauma craniotomy or coronal incision craniotomy.Glasgow outcome scale (GOS) 3 to 6 months after injury showed deaths in 16 patients,vegetative state in 6,severe disability in 13,moderate disability in 24 and good recovery in 37.The mortality in especially acute hematomas was 20.8％ (1 1/53),and acute hematomas was 15.6％ (5/32),subacute hematoma in 11 patients and no death was noted.As for patients with Glasgow coma scale (GCS) scores of 3,the mortality was 100％ (6/6); scores of 4,that was 60％(6/10); scores of 5,that was 10％ (2/20); scores of 6,that was 4.5％ (1/22); scores of 7,that was 4.8％(1/21); scores of 8,no death was noted in 17 patients.The mortality was 53.3％ (8/15) in patients with bilateral pupil dilation and 14.8％ (8/54) in patients with unilateral pupil dilation; 27 patients without pupil dilation showed no death.No patient died after operation when intracranial pressure (ICP) was lower than 30 mmHg in 20 patients; the mortality was 57.1％ in 7 patients when ICP was 30-35mmHg,and that was 100％ (8/8) when ICP was higher than 35 mrnHg.The mortality of 53 patients with midline shift ＜10 mm was 0.Conclusions Patients with rapidly progress,low GCS scores,bilateral mydriasis,midline shift＞10 mm and continuous ICP＞30mmHg after surgery would have high mortality rate and poor prognosis.