29例外伤性大脑半球间硬膜下血肿的临床分析
DOI:
作者:
作者单位:

1.长江大学附属仙桃市第一人民医院神经外科;2.华中科技大学同济医学院附属同济医院神经外科

作者简介:

通讯作者:

基金项目:

国家自然科学基金青年(编号:81602204,81801235)


Clinical analysis of patients with traumatic interhemispheric subdural hematoma in 29 cases
Author:
Affiliation:

神经外科

Fund Project:

  • 摘要
  • |
  • 图/表
  • |
  • 访问统计
  • |
  • 参考文献
  • |
  • 相似文献
  • |
  • 引证文献
  • |
  • 资源附件
    摘要:

    目的:探讨外伤性大脑半球间硬膜下血肿(TISH)的治疗和预后。方法:回顾性分析我院2014年8月-2019年5月收治的29例TISH患者的临床资料。患者治疗后两周由Glasgow预后量表(Glasgow outcome scale, GOS)评估短期疗效。GOS 1-3分为疗效差,GOS 4-5分为疗效好。结果:疗效良好者20例,占69.0%,疗效差者9例,占31.0%。疗效好组治疗后两周Glasgow昏迷评分(GCS)平均为14.6±0.7,疗效差组为9.4±2.2,两组间比较有统计差异(p<0.001)。单因素分析显示影响TISH疗效的因素包括合并合并脑挫裂伤(p=0.032),入院时GCS评分(p<0.001),住院期间病变变化(p=0.049),住院期间GCS极低值(p<0.001),治疗方式(p=0.016)和手术方式(p<0.05)。重症TISH患者(GCS≤8分)中7例行手术治疗,3例非手术治疗。手术组预后良好者占57.2%(n=4),预后差者占42.9%(n=3);而非手术组患者短期预后均较差(n=3)。结论:TISH临床少见,多数患者病情较轻经保守治疗效果较好。部分患者出现迟发性出血,颅内压增高,神经功能障碍等,需严密监护。重症TISH患者手术治疗能够改善预后。

    Abstract:

    Object: To explore the clinical features, therapy strategy and outcomes of patients with traumatic interhemispheric subdural hematoma (TISH). Methods: the clinical data of 29 TISH patients admitted in Neurosurgery department of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from August, 2014 to May, 2019, was retrospectively collected and analyzed. The short-term outcome was evaluated by Glasgow outcome scale (GOS) on two weeks after corresponding treatment. Results: The good curative effect was achieved in 20 cases (69.0%), while the poor outcome was identified in 9 cases (31.0%). The mean GCS on two weeks after treatment was evaluated as 14.6±0.7 in good outcome group, which was significant better than that in poor outcome group (9.4±2.2) (p<0.001). Univariate analysis demonstrated various factors affecting the TISH outcome, such as cerebral contusion (0.032), GCS score at admission (p<0.001), GCS score decreased during hospitalization (p=0.049), and extreme GCS value during hospitalization (p<0.001), treatment (p=0.016) and surgical approach (p<0.05). In severe TISH patients (GCS ≤ 8), 7 patients were treated surgically and three cases received non-surgical treatment. The short-term outcome in surgery group was evaluated as good in 4 cases (57.2%) and poor in 3 patients (42.9%); while the short-term prognosis was poor in all patients in the non-surgical group (n=3). Conclusion: The incidence of TISH was rare. Most TISH was mild illness which might achieve a good outcome by medication treatment. Similarly, a good outcome could be obtained by neuro-monitoring and neurosurgical treatment in some severe cases with delayed hemorrhage, increased intracranial pressure and nerve dysfunction.

    参考文献
    相似文献
    引证文献
引用本文
分享
文章指标
  • 点击次数:
  • 下载次数:
历史
  • 收稿日期:2021-06-01
  • 最后修改日期:2021-07-09
  • 录用日期:2021-07-13
  • 在线发布日期:
新投稿系统运行通知

作者投稿请直接点击左侧“作者登录”,请不要进入旧版入口。如登录或投稿中遇到任何问题,请联系电话13311390237。谢谢!

关闭