Oka K, Kamota T, Satou M, Murakami M, Kobayashi T, Shirasawa B, Mikamo A, Hamano K
Department of Surgery and Clinical Science, Division of Cardiac Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
Kyobu Geka. 2008 Sep;61(10):868-72.
We report 3 cases of subdural hematoma following open heart surgery under cardiopulmonary bypass. In 2 patients, emergency removal and drainage of a subdural hematoma was performed by neurosurgeons, and conservative management was performed in the remaining one. All patients belonged to a high risk group of bleeding due to anticoagulation therapy, and they had no episode of head trauma. Subdural hematomas may have been due to rapid alterations in cerebral volume, leading to a tearing of the dural bridging veins under cardiopulmonary bypass. Although early diagnosis and prompt treatment is very important, it is often difficult to examine neurological findings after cardiac surgery. We consider that patients who need long-term sedation under anticoagulation therapy must have their neurological status checked at least once in a few days.
我们报告了3例在体外循环下心脏直视手术后发生硬膜下血肿的病例。其中2例患者由神经外科医生进行了硬膜下血肿的紧急清除和引流,其余1例进行了保守治疗。所有患者均因抗凝治疗而属于出血高危组,且均无头部外伤史。硬膜下血肿可能是由于脑容量的快速变化,导致体外循环下硬脑膜桥静脉撕裂。尽管早期诊断和及时治疗非常重要,但心脏手术后往往难以检查神经学表现。我们认为,在抗凝治疗下需要长期镇静的患者必须每隔几天至少检查一次神经状态。