文章摘要
首诊时伴有急性出血的慢性硬膜下血肿手术疗效及预后沈晓燕a,赵希敏a,毛青b*
Surgical Efficacy and Prognosis Analysis of Initially Diagnosed Chronical Subdural Hematoma with Acute Bleeding
投稿时间：2024-11-18  修订日期：2024-11-18
DOI：
中文关键词: 慢性硬膜下血肿  急性出血  预后  钻孔引流
英文关键词: chronical subdural hematoma  acute hemorrhage  prognosis  burr-hole drainage
基金项目:国家自然科学基金(名称：miR-30e对电压门控钠通道Nav1.3的调节及其在颅脑创伤中的神经保护作用,批准号：81571883 )
作者单位邮编
沈晓燕 上海市宝山区中西医结合医院 201999
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中文摘要:
      目的： 探讨首诊时伴有急性出血的慢性硬膜下血肿(chronic subdural hematoma,CSDH)手术疗效及预后。方法： 回顾性分析单中心手术治疗的166例CSDH患者的临床资料,其中28例为CSDH合并急性出血(acute-on-chronic subdural hematoma,acSDH),探讨该特殊类型CSDH手术疗效及预后。结果： acSDH占同期CSDH的16.87%。和不伴有急性出血的CSDH比较,acSDH术后并发症发生率高(53.57% v.s. 23.91%,p＜0.05)；而复发率、总住院时间、出院时改良Rankin评分(modified Rankin scale,mRS)两者比较无显著差异(p＞0.05)。82.14% 的acSDH手术疗效良好；30天死亡率和1年死亡率acSDH高于不伴有急性出血的CSDH,但统计学显示无显著差异(p＞0.05)；运用Kaplan-Meier法进行两组生存率比较,差异无统计学意义(p＞0.05)。结论： 首诊伴急性出血的CSDH较不伴急性出血者术后并发症发生率高但复发率无差异；acSDH手术疗效良好,尚需要进一步深入研究明确其长期生存率。
英文摘要:
      Objective: To explore the surgical efficacy and prognosis of chronical subdural hematoma (CSDH) with acute bleeding at the initial diagnosis. Methods: A retrospective analysis was conducted on the clinical data of 166 patients with CSDH who underwent surgical treatment in a single center. Among them, 28 cases were diagnosed with acute-on-chronic subdural hematoma (acSDH), and the surgical efficacy and prognosis of this special type of CSDH were explored. Results: acSDH accounted for 16.87% of CSDH during the same period. Compared with CSDH without acute bleeding, the incidence of postoperative complications in acSDH was higher (53.57% v.s. 23.91%, p<0.05), while there was no statistically significant difference in recurrence, total hospitalization time, and modified Rankin scale (mRS) at discharge (p＞0.05). 82.14% of acSDH patients had good surgical outcomes. The 30-day mortality rate and 1-year mortality rate of acSDH were higher than those of CSDH without acute bleeding, but there was no significant difference in statistics (p＞0.05). The Kaplan-Meier method was used to compare the survival rates of two groups, and there was no statistically significant difference (p>0.05). Conclusions: The incidence of postoperative complications in initially diagnosed acSDH is higher than that CSDH without acute bleeding, but there is no difference in recurrence rate. The efficacy of acSDH surgery is good, and further in-depth research is needed to clarify the long-term survival rate.
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