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醫(yī)學(xué)免費(fèi)論文:老年急性顱內(nèi)血腫的演進(jìn)特點(diǎn)與救治策略
【摘要】 目的 探討老年急性外傷性顱內(nèi)血腫的演進(jìn)特點(diǎn)及相應(yīng)的救治策略。方法 回顧性分析81例老年(>60歲)急性外傷性顱內(nèi)血腫的臨床資料，根據(jù)入院時(shí)傷情輕重分入GCS 3～5分組、GCS 6～8分組和GCS 9～13分組，并與90例入院時(shí)傷情程度相當(dāng)?shù)那嗄昊颊?<35歲)作比較，統(tǒng)計(jì)分析組間不同的臨床特點(diǎn)和治療反應(yīng)，包括血腫變化量、意識(shí)變化量、接受手術(shù)例數(shù)構(gòu)成比、傷后住NICU(神經(jīng)重癥監(jiān)護(hù)室)時(shí)間、并發(fā)癥發(fā)生率、死亡率。結(jié)果 GCS 3～5分患者中，老年組與青年組在血腫量、意識(shí)水平變化量、死亡率方面無顯著差異(P>0.05)，老年組接受手術(shù)例數(shù)比和傷后住NICU時(shí)間顯著低于與青年組(P<0.05)，并發(fā)癥發(fā)生例數(shù)比顯著高于青年組(P<0.05);GCS 6～8分患者中，老年組與青年組在血腫量、意識(shí)水平變化量、接受手術(shù)例數(shù)比和傷后住NICU時(shí)間方面無顯著差異(P>0.05)，老年組在并發(fā)癥發(fā)生比、死亡率上顯著高于青年組(P<0.05);GCS 9～13分患者中，老年組在入院時(shí)血腫量、傷后24小時(shí)血腫量、傷后48小時(shí)血腫量、血腫總變化量、意識(shí)變化量、接受手術(shù)例數(shù)比、傷后住NICU時(shí)間、并發(fā)癥發(fā)生比、死亡率方面均高于青年組且有統(tǒng)計(jì)學(xué)意義(P<0.05)，老年組傷后48小時(shí)血腫量較24小時(shí)血腫量顯著增加(P<0.05)。結(jié)論 GCS 3～5分的老年患者，爭奪救治時(shí)機(jī)是關(guān)鍵;GCS 6～8分老年急性顱內(nèi)血腫患者，提高應(yīng)對(duì)并發(fā)癥的防治能力是增加救治成功率的關(guān)鍵;GCS 9～13分的老年患者，延長重癥監(jiān)護(hù)期、密切CT隨訪是救治成功的關(guān)鍵。
【關(guān)鍵詞】 顱腦損傷;顱內(nèi)血腫;治療;老年醫(yī).學(xué).全.在.線m.gydjdsj.org.cn
Clinical development and surgical strategy of acute intracranial hematoma in elderly patients
YANG Tiancheng,YAN Yi,ZHONG Dong,ZENG Fanchuan,WEN Yu,HU Mingliang,XIE Xingan
(Department of Surgery,People's Hospital of Dianjiang County,Chongqing 408300，China;Department of Neurosurgery,First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
【Abstract】 Objective To study the clinical development and surgical strategy of acute traumatic intracranial hematoma in the aged patients.Methods Eightyone elderly patients (>60 years) with acute traumatic intracranial hematomas and ninety young patients (<35 years) with the same severity of brain injury were included in this retrospective study.All patients were classified into three groups as GCS 3 to 5,GCS 6 to 8 and GCS 9 to 13 according to severity at the time of admission.Clinical features and efficacy,including volume of hematoma at admission(Ha),consciousness index(Ci),ratio of surgical number(Nsr),time of in ICU (TICU),ratio of complication number(Ncr),and mortality (M),were analysed between groups.Results In the group of GCS 3 to 5,Ha,Ci and M were not significantly different between old patients and young patients(P>0.05).Nsr and TICU in elderly patients were significantly less than those in young patients(P<0.05), Ncr was more than that in young cases(P<0.05).In the group of GCS 6 to 8,no significant difference in parameters of Ha,Ci,Nsr,TICU was observed(P>0.05); Ncr and M in elderly cases were higher than those in young cases(P<0.05).In the group of GCS 9 to 13,almostly all clinical measurement,including Ha,volume of hematoma at 24 hours after admission (Ha24),volume of hematoma at 48 hours after admission (Ha48),index of hematoma(Hi),Ci,Nsr,TICU,Ncr and M in group of aged were differed significantly from those in young patients group(P<0.05).In the group of elderly patients,Ha48 was higher compared with Ha24(P<0.05).Conclusion According to the characteristic of acute traumatic intracranial hematomas,the key of successful treatment is to gain opportunity of operation for patients with GCS 3 to 5,to prevent and control complication for patients with GSC 6 to 8,and to prolong the period of intensive care and promptly reexamine CT scan for patients with GSC 9 to 13.
【Key words】brain injury;intracranial hematoma;treatment;elderly
