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目的:探讨颅脑外伤后进展性出血性损伤发病机制及早期诊断。方法:按血肿发生的部位、发生的时间、与GCS及原发颅脑损伤的关系、对收集本院脑外科63例颅脑外伤后进展性出血性损伤进行回顾分析..结果:63例颅脑外伤后进展性出血性损伤,其中硬膜外血肿12例,硬膜下血肿15例,脑内血肿29例,多发性血肿7例。发生时间多在伤后24 h内76%(48/63)。按入院时格拉斯哥昏分级(GCS)评分以9～12分为多57%(36/63);伤后低血压,缺氧,凝血障碍,术后颅压下降失去填塞效应、是进展性出血损伤发生的重要因素。结论:颅脑外伤首次CT有脑挫裂伤、蛛网膜下腔出血、颅骨骨折均有进展性出血性损伤发生的可能,GCS评分9～12分为多(57%)。大多发生在伤后24 h内,细致观察及颅内压监测,每4～6 h复查CT多能早期发现,提高治疗效果,降低病死率。
Objective: To investigate the pathogenesis and early diagnosis of progressive hemorrhagic injury after traumatic brain injury. Methods: According to the site of hematoma, the time of occurrence, the relationship with GCS and primary craniocerebral injury, 63 cases of progressive hemorrhagic injury after craniocerebral trauma were retrospectively analyzed.Results: Progressive hemorrhagic injury after traumatic brain injury, including 12 cases of epidural hematoma, subdural hematoma in 15 cases, 29 cases of intracerebral hematoma, multiple hematoma in 7 cases. Occurred more time within 24 h after injury 76% (48/63). At admission, Glasgow Faint Grading (GCS) scores were 57% (36/63) more than 9-12; post-traumatic hypotension, hypoxia, coagulopathy, and postoperative loss of intracranial pressure had a loss of packing effect and were progressive hemorrhagic lesions An important factor that happened. CONCLUSION: The first CT of traumatic brain injury has cerebral contusion, subarachnoid hemorrhage and skull fracture with progressive hemorrhagic injury. GCS score is 9-12 (57%). Most occurred within 24 h after injury, careful observation and monitoring of intracranial pressure, CT every 4 ~ 6 h to find early detection, improve the therapeutic effect and reduce mortality.