目的:探讨外伤性颅内迟发性血肿CT表现特点和规律,为临床即时诊治提供可靠依据。方法:对136例外伤性颅内迟发性血肿患者首次CT及伤后迟发性血肿发生时间进行分析。结果:外伤性颅内迟发性血肿患者多数首次CT检查,可仅表现为蛛网膜下腔出血、脑肿胀、脑挫裂伤和颅骨骨折;颅内迟发性血肿发生的高峰期为伤后24～72小时。结论:外伤性颅内迟发性血肿首次CT检查多有异常,但无颅内血肿者,应在24~72小时内进行CT复查,以发现颅内迟发性血肿,方不至贻误诊治。
Objective To explore the clinical features of spontaneous spinal epidural hematoma (SSEH) and to find out factors influencing its prognosis. Methods From September 1998 to October 2006, 23 patients with SSEH (10 males and 13 females) were treated. Their ages ranged from 10 to 69 years. The primary neurological status were classified as grade A in 7 patients,B in 2 patients, C in 4 patients, D in 9 patients and E in 1 patients accordingto ASIA grading system. The progressive intervals of their symptoms were divided as four period: less than 12 hours (12 patients), 12 to 24 hours(2 patients), 24 to 48 hours(3 patients) and more than 48 hours(6 patients). SSEH was diagnosedby MRI or by histopathological examination. The cases history, laboratory examination, radiological image, treatment, pathological result and prognosis were recorded and analyzed after 3 month. Results In 23 patients, there were 1 case of deterioration, 8 cases of no change, 9cases of improvement and 5 cases of complete recovery. The gender had no correlationwith prognosis(P＞0.05). In the patients who had shorter progressive interval and more severe edema of spinal cord, the prognosis was worse(P＜0.05). Inthe patients who had mild neurological deficit, the prognosis was good (P＜0.01). In 17 patients undergoing surgery, the scores for prognosis was 1 point in 1 case, 2 points in 5 cases, 3 points in 6 cases and 4 points in 5 cases; the operation time had no correlation with prognosis(r=0.056, P＞0.05). In6patients undergoing conservative treatment, the scores for prognosis were 2 points and 3 points in 3 cases respectively. Conclusion Prognosis of patient with SSEH is influenced by his primary neurological status, progressive interval, spinal edema and size of hematoma. The major treatment is surgical evacuation of hematoma as early as possible to break the aggravation of spinal function. Conservative treatment is not considered unless the neurological defects recovered in the early period.
目的:探讨慢性硬膜下血肿的临床及诊疗要点。方法:回顾性分析138例慢性硬膜下血肿患者的临床资料。结果:1例术中大出血死亡,其余137例均治愈出院。术后硬膜下积液2例,脑内血肿5例,张力性气颅2例,癫痫发作3例,3例复发。结论:头颅CT平扫是诊断CSDH的首选检查。对于有症状的CSDH患者,应根据血肿的特点,选择合适的术式,而积极防治手术并发症是治疗CSDH的关键。
目的 探讨糖尿病对主动脉壁内血肿的预后影响。 方法 纳入 2012 年 10 月至 2014 年 11 月我院连续 24 例主动脉壁内血肿患者，其中男 17 例、女 7 例，年龄（58.83±10.42）岁，定期复查主动脉 CTA（复查时间为 3～4 周），观察糖尿病患者和非糖尿病患者主动脉壁内血肿的进展情况。 结果 24 例患者在复查时，出现 A 型主动脉夹层 2 例，B 型主动脉夹层 3 例（均为腹部局限性夹层）；4 例患者合并糖尿病，复查时 2 例进展为主动脉夹层，2 例血肿及溃疡加重。 结论 主动脉壁内血肿整体呈吸收趋势，无并发症发生。手术事件的发生率与患者合并糖尿病有密切关系。
ObjectivesTo explore the efficacy and prognostic factors of neuroendoscopic intracerebral hematoma evacuation in the treatment of hypertension-related intracerebral hemorrhage.MethodsA total of 122 patients with hypertension-related intracerebral hemorrhage treated in our hospital from October 2015 to May 2019 were categorized into experimental group (n=62) and control group (n=60). The experimental group was treated with endoscopic intracerebral hematoma removal, while the control group was treated with traditional craniotomy. The operative indexes, postoperative recovery, serum endothelin, IL-6, CRP levels and the incidence of postoperative complications were observed and compared between the two groups, and the relevant factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation were analyzed.ResultsThe operation time, intraoperative blood loss, hematoma clearance rate, ICU treatment time, the volume of brain edema 7 days after operation, the postoperative intracranial pressure, NIHSS score and ADL score in experimental group were significantly superior to those in control group. The levels of serum endothelin, IL-6 and CRP in the experimental group were significantly lower than those in the control group after operation. The incidence of complications in the experimental group was lower than that in control group. Univariate analysis showed that the prognosis of patients undergoing neuroendoscopic evacuation of intracerebral hematoma was significantly correlated with the history of hypertension, preoperative GCS score, the amount of bleeding and whether been broken into the ventricle (P<0.05), but not with age, sex and location of hemorrhage (P>0.05). Multivariate logistic regression analysis showed that the history of hypertension above 10 years, blood loss above 50 mL, intraventricular rupture and preoperative GCS score were the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.ConclusionsCompared with traditional craniotomy, neuroendoscopic evacuation of intracerebral hematoma has the advantages of better curative effect and lower incidence of postoperative complications in the treatment of hypertension-related intracerebral hemorrhage. The history of hypertension above 10 years, bleeding volume above 50 mL, breaking into the ventricle and preoperative GCS score are the risk factors affecting the prognosis of patients undergoing neuroendoscopic intracerebral hematoma evacuation.
目的:探讨对合并脑疝形成的外伤性颅内血肿患者进行小硬脑膜窗口显露预防急性脑膨出的临床价值。方法:收集我院2005年1月至2007年1月收治符合标准的合并脑疝形成的外伤性颅内血肿患者126例,均行开颅去大骨瓣减压手术,治疗组67例行小硬脑膜窗口显露的方式进行血肿清除术,对照组59例采用传统的硬脑膜切开进行清除血肿清除术。结果:治疗组患者颅内压下降速度和程度优于对照组(Plt;0.05),治疗组术中急性脑膨出的发生率低于对照组(Plt;0.05)。结论:小硬脑膜窗口显露是预防急性脑膨出发生的一种有效手术方式。