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Analysis of 25 Gerontal Patients with Bilateral Chronic Subdural Hematoma

目的:探讨双侧慢性硬膜下血肿(BCSDH)的诊断和治疗。方法:对25例老年患者BCSDH的诊断,治疗资料总结分析,全部病例均行CT/或MRI检查。所有患者皆行颅骨钻孔引流术,其中5例单侧钻孔引流,20例双侧钻孔引流。结果:全部病例均治愈,随访未见复发。结论:CT和MRI检查是BCSDH的最佳诊断手段。钻孔引流是BCSDH的有效治疗方法。

Management of Chronic Subdural Hematoma by Improved Trepanation and Drainage

目的:改良钻孔引流术治疗慢性硬膜下血肿27例,提高临床治疗效果。方法:术中可控下持续生理盐水冲洗后,加入尼莫地平注射液排空,术后低渗或等渗液体维持脑灌注压。结果:27例慢性硬膜下血肿经上述措施处理后,经随访均达到满意临床治疗效果。结论:慢性硬膜下血肿钻孔引流术中加用尼莫地平注射液冲洗、排气,及规范化术后处理措施可提高临床疗效。

Analysis on the Related Factors of Recurrence of Chronic Subdual Hematoma after Neurosurgery

摘要:目的:探讨慢性硬膜下血肿(chronic subdural hematoma, CSDH)钻孔冲洗引流术后的复发因素。方法：回顾性分析165例CSDH钻孔冲洗+闭式引流术的治疗效果,并结合患者年龄、术后引流量、血肿腔是否有间隔、血肿厚度、引流管安放方向等因素进行相关分析。结果:本组治愈151例,血肿复发14例。〖HTH〗结论〖HTSS〗:患者年龄、术后引流量、血肿腔是否有间隔、血肿厚度、引流管安放方向是影响复发的主要因素。Abstract: Objective: To explore the related factors of recurrence of chronic subdural hematoma after burr hole drainage.Methods:The related aspects that affected the recurrence in 165 cases with chronic subdural hematomas after burr hole drainage were reviewed,and patient’s age,drainage volume,thickness of hematoma, septal hematoma cavity and direction of drain pipe were evaluated.Results:Clinical outcomes were satisfactory.151 patients completely recovered after burr hole drainage,there were 14 patients with hematoma recurrence. Conclusion : Age, drainage volume, thickness of hematoma, septal hematoma cavity and direction of drain pipe would affect the prognosis.

The Clinical Analysis on Cerebral Infarction after Operation for Subdural Hematoma in Senile Patients

摘要:目的:探讨老年慢性硬膜下血肿术后脑梗死的发病特点及防治措施。方法:总结分析21例老年慢性硬膜下血肿术后出现脑梗死患者。结果:多数患者具有高血压、高血脂、冠心病及糖尿病等多个脑梗死高危因素。术后脑梗死发生于术后1周内者18例,其中3天以内者16例;脑梗死发生于手术区域附近者14例,非手术区域附近者7例,其中5例的脑梗死发生于上述两个区域。结论:脑梗死发病的高危因素是颅脑术后脑梗死发生的主要原因。Abstract: Objective: To investigate and search for the causes of cerebral infarction after operation for subdural hematoma in senile patients and discuss the remedies for its prevention. Methods: Twentyone senile patients with cerebral infarction after operation for subdural hematoma were reviewed retrospectively. Results: Most of the patients were found to be suffered with several risk factors of cerebral infarction such as hypertension, coronary cardiac diseases, diabetes mellitus and so on. Eighteen cases of infarctions occurred within a week after operation, including 16 cases within 3 days. Fourteen cases of the infarctions located in regions around the operative field, while 7 cases in non operation related area, and 5 cases in both areas. Conclusions: Risk factors of cerebral infarction were the main causes to result in cerebral infarction after operation for subdural hematoma.

自发性低颅压综合征致小脑扁桃体下疝及硬膜下血肿护理一例

慢性硬膜下血肿钻孔引流术中冲洗与不冲洗疗效对比研究

目的对比分析慢性硬膜下血肿钻孔引流术中冲洗与不冲洗不同手术操作方法对患者术后疗效及并发症的影响。 方法回顾性收集 2013 年 1 月—2014 年 12 月在四川大学华西医院神经外科就诊的 81 例单侧慢性硬膜下血肿患者临床及影像学资料，患者分别采用钻孔引流+术中生理盐水彻底冲洗+术后引流治疗（冲洗组 46 例）及钻孔置管引流不行冲洗治疗（引流组 35 例），应用 3D-Slicer 软件精确测量术后 1 d 颅内积气量及出院残余血肿量，对测量数据及并发症发生情况进行对比分析，并利用术后门诊随访及电话随访资料对比分析血肿复发情况。 结果术后第 2 天冲洗组与引流组患者颅内积气量分别为（9.98±4.73）、（3.78±1.80）mL，差异有统计学意义（P<0.05）；冲洗组与引流组术后发生新鲜出血概率分别为 6.5%、2.9%，出院前残余血肿量分别为（9.82±3.20）、（10.94±4.34）mL，血肿复发率分别为 6.5%、8.6%，差异均无统计学意义（P>0.05）。 结论钻孔引流术中冲洗能快速引流出硬膜下血肿，但明显增加术后颅内积气，并可能增加出血风险，且远期疗效与不冲洗组相比无明显差异，故钻孔引流无需术中冲洗。由于样本量及设计学缺陷，尚需大规模随机对照试验作进一步验证。