Sawauchi Satoshi, Murakami Shigeyuki, Ogawa Takeki, Abe Toshiaki
Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567, Japan.
No Shinkei Geka. 2007 Jan;35(1):43-51.
Traumatic acute subdural hematomas (ASDH) in Japan Neurotrauma Data Bank were categorized into focal brain injury (FBI) group and diffuse brain injury (DBI) group, and were analyzed to clarify the pathophysiological and therapeutic aspects of these injuries.
Data in Japan Neurotrauma Data Bank were reviewed for 1,002 severely head-injured patients treated at hospitals between 1998 and 2001; 526 of these patients had ASDH. ASDH in this data bank were categorized into FBI group and DBI group on the findings of CT scan. The clinical variables in these injuries were evaluated.
Of 526 patients with ASDH, 246 (46.8%) were categorized into FBI group, 280, (53.2%) were DBI group. The patients with DBI group were younger, injured in traffic accident, lower Glasgow Coma Scale (GCS), higher Injury Severity Score, poorer outcome, compared to those with FBI group. The patients in DBI group, who underwent decompressive craniectomy and craniotomy, had a significantly better outcome than those who underwent hematoma evacuation via burr hole. There were no relationship between the time from injury to operation and outcome in the patients with DBI group, whereas patients with early surgery in FBI group showed significantly poorer outcome. Hypothermia and the placement of intracranial pressure monitor improved outcome only in patients of DBI group.
It seems that the pathophysiological and therapeutic aspects of ASDH associated with DBI might differ from that with FBI alone.
日本神经创伤数据库中创伤性急性硬膜下血肿（ASDH）被分为局灶性脑损伤（FBI）组和弥漫性脑损伤（DBI）组，并进行分析以阐明这些损伤的病理生理和治疗方面。
回顾了日本神经创伤数据库中1998年至2001年期间在医院接受治疗的1002例重度颅脑损伤患者的数据；其中526例患者患有ASDH。根据CT扫描结果，将该数据库中的ASDH分为FBI组和DBI组。对这些损伤的临床变量进行评估。
在526例ASDH患者中，246例（46.8%）被分为FBI组，280例（53.2%）为DBI组。与FBI组患者相比，DBI组患者更年轻，因交通事故受伤，格拉斯哥昏迷量表（GCS）评分更低，损伤严重程度评分更高，预后更差。接受去骨瓣减压术和开颅手术的DBI组患者的预后明显优于通过钻孔引流血肿的患者。DBI组患者从受伤到手术的时间与预后之间没有关系，而FBI组早期手术的患者预后明显更差。低温治疗和颅内压监测仅在DBI组患者中改善了预后。
与DBI相关的ASDH的病理生理和治疗方面似乎可能与仅与FBI相关的情况不同。
