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目的分析重型颅脑损伤术后颅内再出血的临床处理及预后。方法选择重型颅脑损伤术后再出血患者50例,观察再出血部位,分析患者临床处理结果及预后。结果 50例中,原发血肿区再出血32例(64.0%),原发血肿对侧出血15例(30.0%),其他部位出血3例(6.0%)。再次手术39例(78.0%),保守治疗11例(22.0%)。患者经治疗后血肿清除效果良好,无脑水肿加重,患者均无死亡。术后GOS:2级1例(2.0%),3级2例(4.0%),4级12例(24.0%),5级35例(70.0%)。结论重型颅脑损伤术后再出血以原发血肿区出血为主,应积极治疗,改善患者预后。
Objective To analyze the clinical treatment and prognosis of intracranial hemorrhage after severe craniocerebral injury. Methods Fifty patients with rebleeding after severe craniocerebral injury were selected, the rebleeding site was observed, and the clinical outcome and prognosis were analyzed. Results Of the 50 cases, 32 (64.0%) had rebleeding in the primary hematoma area, 15 (30.0%) contralateral to the primary hematoma, and 3 (6.0%) bleeding in other sites. Reoperation in 39 cases (78.0%), conservative treatment in 11 cases (22.0%). After treatment, hematoma removal was effective and no brain edema was exacerbated. All patients did not die. Postoperative GOS: grade 1 in 2 (2.0%), grade 3 in 2 (4.0%), grade 4 in 12 (24.0%) and grade 5 in 35 (70.0%). Conclusion Severe craniocerebral injury with hemorrhage after primary hematoma bleeding should be actively treated to improve prognosis.