【摘要】 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。更多还原

【Abstract】 Objective:To investigate the mechanism and early diagnosis of progressive hemorrhagic lesions after brain injury.Methods:Sixty-three patients with post-traumatic progressive hemorrhagic lesions were retrospectively studied based on the site and time of onset related to GCS and primary brain injury.Results:The 63 cases of progressive hemorrhage after traumatic brain injury included 12 cases of epidural hematoma,15 of subdural hematoma, 29 of intracerebral hematoma,and 7 of multiple hematomas which mostly occurred within 24h from the injury 76%(48/ 63).Glasgow coma scores(GCS) at admission were 9 to 12 in 57%(36/63) of these patients.Post-traumatic hypotension,hypoxia,coagulation disorder,and lowered intracranial pressure after loss of tamponade effect,seemed to be important factors leading to progressive hemorrhage injury.Conclusion:Progressive hemorrhagic lesions may be likely to occur in those with cerebral contusion or laceration,subarachnoid hemorrhage and skull fractures as shown by primary brain CT.Such conditions may frequently measur 9 - 12 in GCS,and mostly occurred within 24h after the injury. Careful inspection and monitoring of intracranial pressure as well as CT scanning repeated at 4 - 6 h intervals can be useful for early diagnosis,improved outcomes and reduction of fatality rate.更多还原