Jamjoom A
Division of Neurosurgery, King Khalid University Hospital, Riyadh, Saudi Arabia.
Injury. 1992;23(8):518-20. doi: 10.1016/0020-1383(92)90149-m.
The author has reviewed the outcome of 27 patients aged 75 years and over who had an operation for acute traumatic subdural haematoma at Frenchay Hospital, Bristol, over a 10-year period. There were 15 men and 12 women with a mean age of 79.2 years. The outcome at 6 months was determined using the Glasgow Outcome Score. Of the patients, 15 per cent made a good recovery, 15 per cent a poor recovery and 70 per cent died. The influence of age, sex, mechanism of injury, preoperative Glasgow Coma Score (GCS), pupillary reactivity to light, skull and limb fractures, clinical course, CT scan appearance and timing of operation were analysed in relation to the outcome. The results showed that a preoperative GCS of 4 or less and unilateral pupillary dilatation and non-reactivity to light were not compatible with good survival in the very elderly patient with acute subdural haematoma. Under these circumstances, operation is not justified. The prognosis was worse in patients who were unconscious immediately after injury and with a CT scan showing a subdural haematoma and a haemorrhagic contusion which required urgent early intervention. The prognostic indicators present may prove useful in the selection of patients for active surgical intervention.
作者回顾了10年间在布里斯托尔的弗伦奇医院接受急性创伤性硬膜下血肿手术的27例75岁及以上患者的治疗结果。其中男性15例，女性12例，平均年龄79.2岁。采用格拉斯哥预后评分来确定6个月时的治疗结果。结果显示，15%的患者恢复良好，15%的患者恢复较差，70%的患者死亡。分析了年龄、性别、损伤机制、术前格拉斯哥昏迷评分（GCS）、瞳孔对光反应、颅骨和四肢骨折、临床病程、CT扫描表现及手术时机对治疗结果的影响。结果表明，术前GCS≤4分、单侧瞳孔散大且对光无反应，对于患有急性硬膜下血肿的高龄患者而言，预后良好的生存可能性不大。在这种情况下，手术并不合理。受伤后即刻昏迷且CT扫描显示硬膜下血肿和出血性挫伤并需要紧急早期干预的患者，预后更差。现有的这些预后指标可能对选择积极手术干预的患者有用。
