Bullock R, Hanemann C O, Murray L, Teasdale G M
Institute of Neurological Sciences, Southern General Hospital, Glasgow, Scotland.
J Neurosurg. 1990 Jan;72(1):9-14. doi: 10.3171/jns.1990.72.1.0009.
Of 850 patients who underwent craniotomy for evacuation of a traumatic intracranial mass, 59 (6.9%) developed a second hematoma at the operation site, which required a second operation. Compared to those who did not, patients who developed postcraniotomy hematoma (PCH) had a significantly higher incidence of evidence of alcohol intake and preoperative mannitol administration; a higher percentage had a bad outcome. Coagulopathy was frequent in PCH patients. Although three-quarters of the initial hematomas were intradural, 69% of the PCH's were predominantly extradural. The large potential space underlying a craniotomy bone flap may predispose to development of a PCH. Intracranial pressure (ICP) was monitored in 39 of the 59 PCH patients, which allowed earlier detection of the PCH in 22 (56%). In 17 patients, the ICP failed to rise despite clinical deterioration, and detection of the PCH was delayed, significantly worsening the outcome in this group.
在850例因外伤性颅内肿块行开颅血肿清除术的患者中，59例（6.9%）在手术部位出现了二次血肿，需要进行二次手术。与未出现二次血肿的患者相比，发生开颅术后血肿（PCH）的患者酒精摄入和术前使用甘露醇的证据发生率显著更高；不良结局的比例更高。凝血功能障碍在PCH患者中很常见。虽然最初的血肿中有四分之三位于硬膜内，但69%的PCH主要位于硬膜外。开颅骨瓣下方的巨大潜在空间可能易导致PCH的发生。59例PCH患者中有39例进行了颅内压（ICP）监测，这使得22例（56%）的PCH得以更早发现。在17例患者中，尽管临床症状恶化，但ICP并未升高，PCH的发现被延迟，这组患者的结局明显恶化。
