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目的探讨外颅脑损伤术后对侧迟发性颅内血肿的预防、诊断及治疗措施,降低颅脑损伤术后对侧颅内血肿的发生率、提高及时诊出率、增加抢救与治疗成功率,改善患者预后。方法对神经外科2005年7月22日—2013年8月6日共计83例颅脑损伤术后发生对侧迟发性颅内血肿患者的病因、临床症状、诊断、治疗及预后结合相关文献进行回顾性临床分析。结果 83例患者均通过电话、短信、网络等方式进行随访,所有患者都随访6个月。6个月后,按GOS评分,恢复良好,生活自理者47例,轻度残疾,生活基本自理者16例,重度残疾,生活需要照料者9例,植物生存,仅有最小反应者5例,死亡3例,失访3例。结论颅脑损伤术后对侧迟发性颅内血肿在临床上并非罕见,约占颅脑损伤手术患者的10%,该疾病病情进展迅速,迟发性血肿会对患者造成二次打击并可导致术后顽固性颅高压,使病情进行性加重并导致严重后果;部分患者病情隐蔽,不易被及时发现而贻误最佳抢救时机,一旦病情恶化,可延长患者恢复期并使患者预后变差甚至导致患者死亡,合理的初次手术方案,及时合理的影像学检查以早期发现,及时有效的处理是降低颅脑损伤术后对侧迟发性颅内血肿的发生率及改善患者预后、提高生存质量的关键。
Objective To investigate the prevention, diagnosis and treatment of delayed traumatic intracranial hematoma after external craniocerebral injury and to reduce the incidence of intracranial hematoma after craniocerebral injury, to improve the timely diagnosis rate and increase the success of emergency treatment and treatment Rate, improve patient prognosis. Methods From July 22, 2005 to August 6, 2013, a total of 83 cases of patients with contralateral delayed intracranial hematoma were enrolled in this study. The etiology, clinical symptoms, diagnosis, treatment and prognosis of 83 patients with traumatic brain injury Retrospective clinical analysis. Results 83 patients were followed up by phone, SMS, Internet, etc. All patients were followed up for 6 months. Six months later, according to the GOS score, the recovery was good. There were 47 cases of self-care living, 16 cases of mild disability and basic self-care, 9 cases of severe disability, need of care, 9 cases of plant survival, 5 cases with minimal response, 3 died, 3 lost to visit. Conclusions The delayed delayed intracranial hematoma after craniocerebral injury is not uncommon in clinic, accounting for about 10% of the patients with craniocerebral injury. The disease progresses rapidly and delayed hematoma can cause secondary attack to patients Leading to intractable intracranial hypertension, aggravating the disease and causing serious consequences; some patients in subtle conditions, not easy to be discovered and delayed the best time to rescue, as soon as the condition deteriorated, patients can prolong the recovery and prognosis worse or even worse Leading to patient death, a reasonable initial surgical plan, timely and reasonable imaging to detect early detection, timely and effective treatment is to reduce the incidence of delayed traumatic intracranial hematoma after craniocerebral injury and improve prognosis and improve quality of life key.