【摘要】 目的探讨广泛脑挫裂伤后迟发性颅内血肿(DT ICH)的发病机制、早期诊断及手术指征,以提高临床疗效。方法同期收治86例广泛脑挫裂伤后DT ICH患者,均行动态CT检查,63例行开颅血肿清除术,23例行保守治疗。结果手术治疗者出院时GO S评分良好42例,中残4例,重残7例,植物生存4例,死亡6例;非手术治疗者中1例自动出院,2例突发枕骨大孔疝死亡,余20例血肿吸收、恢复良好。结论脑挫裂伤和蛛网膜下腔出血是DT ICH的重要原因,其他可能因素包括血管舒缩机制障碍、填塞效应解除学说及血凝障碍学说;复查CT是发现并诊断DT ICH的有效方法;对有明显占位效应者尽快手术清除血肿,非手术治疗要谨慎。更多还原

【Abstract】 [Objective]To increase the therapeutic effectiveness of delayed traumatic intracerebral hematomas(DTICH) after extensive contusion and laceration of brain by investigating the pathological mechanism,the early diagnosis and surgical indications.[Methods] 86 cases of DTICH after extensive contusion and laceration of brain were reviewed,they were all performed dynamic CT examination.63 cases were performed with haematoma cleaning operation and 23 were treated with conservative management.[Results] According to Glasgow out come scale(GOS),there were 42 cases recovered well when discharged,4 disabled moderately,7 disabled severely,4 cases survived at vegetative state,6 died in operation group.6 month later.GOS showed 45 cases recovered well,3 disabled lightly,6 disabled severely,2 survived as vegetable,6 died;Among non-operation group,20 cases were discharged when the hematomas were absorbed,2 died of transforamen magna herniation,1 was discharged automaticly. [Conclusions] The main reasons of DTICH are extensive contusion and laceration of brain and subarachnoid haemorrhage.other possible reasons include vasoconstriction and vasodilatation disfunction.filling effect releasseing theory and coaqulation disfunction.Re-examinaton with CT is the effective method to find and diagnose DTICH.The volume of bleeding is less and brain is not obviously compressed should be cured with non-operation carefully.The hematomas with occupancy obviously,should be cleared up as quickly as possible.Early diagnosis is the key to improve the prognosis.更多还原