硬膜外血肿和硬膜下血肿的非手术治疗：对于直径1厘米或更小的病灶是否安全？

Nonoperative management of epidural hematomas and subdural hematomas: is it safe in lesions measuring one centimeter or less?

作者信息

De Souza Michelle, Moncure Michael, Lansford Todd, Albaugh Gregory, Tarnoff Michael, Goodman Martin, Endress Ryan, Ross Steven E

机构信息

Department of Surgery, UMDNH-Robert Wood Johnson Medical School, Cooper University Hospital, Camden, NJ, USA.

出版信息

J Trauma. 2007 Aug;63(2):370-2. doi: 10.1097/TA.0b013e318124a95b.

DOI:10.1097/TA.0b013e318124a95b

PMID:17693838

Abstract

BACKGROUND

Management of a patient with a closed head injury is based on neurologic status and computerized tomography scan results. We hypothesized that those patients with an epidural hematoma (EDH) or subdural hematoma (SDH) <1 cm in thickness could safely be treated nonoperatively.

METHODS

We retrospectively reviewed charts of 204 consecutive patients with either an EDH or SDH.

RESULTS

There were 122 lesions < or =1 cm and 82 lesions >1 cm. In the first group, 115 were managed nonoperatively, with 111 good outcomes (minimal deficit with a Rancho Los Amigos score [RLAS] > or =3), two poor outcomes (severely disabled with RLAS <3), and two deaths. Twenty-eight patients with lesions greater than 1 cm had concomitant cerebral edema (CE) with an 89% mortality rate. The mortality rate in this group without CE was 20%, demonstrating the presence of CE in this group may have adversely affected the mortality rate, regardless of intervention.

CONCLUSIONS

This data suggests that EDH or SDH <1 cm thick can be safely managed nonoperatively unless there is concomitant CE.

摘要

背景

闭合性颅脑损伤患者的治疗基于神经学状态和计算机断层扫描结果。我们推测，硬膜外血肿（EDH）或硬膜下血肿（SDH）厚度<1 cm的患者可以安全地接受非手术治疗。

方法

我们回顾性分析了204例连续的EDH或SDH患者的病历。

结果

有122个血肿厚度≤1 cm，82个血肿厚度>1 cm。在第一组中，115例接受非手术治疗，其中111例预后良好（Rancho Los Amigos评分[RLAS]≥3，轻度功能障碍），2例预后差（RLAS<3，严重残疾），2例死亡。28例血肿厚度大于1 cm的患者伴有脑水肿（CE），死亡率为89%。该组无CE患者的死亡率为20%，表明无论采取何种干预措施，该组中CE的存在可能对死亡率产生了不利影响。