Shiomi Naoto, Echigo Tadashi, Oka Hideki, Nozawa Masahiro, Okada Michiko, Hiraizumi Shiho, Kato Fumitaka, Koseki Hirokazu, Hashimoto Yoichi, Hino Akihiko
Department of Emergency and Critical Care Medicine, Saiseikai Shiga Hospital.
No Shinkei Geka. 2017 Feb;45(2):155-160. doi: 10.11477/mf.1436203468.
The outcome of severe acute subdural hematoma is unfavorable. In particular, patients with levels of consciousness of Glasgow Coma Scale(GCS)3 or 4 tend to be refractory to treatment. Decompressive craniotomy should be promptly performed to remove hematoma. However, if an operating room is not immediately available, emergency burr hole surgery is sometimes performed in the emergency room(primary care room)prior to craniotomy. A previous study has reported that the interval from injury to surgery influences the outcome of severe acute subdural hematoma. Therefore, emergency decompression is important to effectively treat patients with severe acute subdural hematoma. We present the cases of two patients with acute subdural hematomas. In both cases, emergency decompressive craniotomy(hematoma removal after craniotomy and external decompression)was performed in the emergency room of the Emergency and Critical Care Center. In both cases, the surgery was followed by favorable outcomes. Case 1 was a 36-year-old female. The patient's level of consciousness upon arrival was GCS 3. The interval from injury to diagnosis on the basis of CT findings was 75 minutes. Surgery began 20 minutes after diagnosis. Case 2 was a 25-year-old male. The second patient's level of consciousness upon arrival was GCS 4. The interval from injury to diagnosis on the basis of CT findings was 60 minutes. Surgery was begun 40 minutes after diagnosis. In both patients, we observed anisocoria and the loss of the light reflex. However, the postoperative course was favorable, and both patients were discharged. In summary, to treat severe acute subdural hematomas, early emergency decompressive craniotomy is optimal. Emergency decompressive surgery in the emergency room is independent of operating room or staff. Therefore, emergency decompressive craniotomy may improve the outcome of patients with severe acute subdural hematomas.
严重急性硬膜下血肿的预后不佳。特别是格拉斯哥昏迷量表（GCS）评分为3或4分的患者往往对治疗反应不佳。应立即进行去骨瓣减压术以清除血肿。然而，如果手术室不能立即使用，有时会在开颅手术前在急诊室（基层护理室）进行紧急钻孔手术。先前的一项研究报告称，受伤至手术的时间间隔会影响严重急性硬膜下血肿的预后。因此，紧急减压对于有效治疗严重急性硬膜下血肿患者很重要。我们介绍了两名急性硬膜下血肿患者的病例。在这两个病例中，均在急诊与重症监护中心的急诊室进行了紧急去骨瓣减压术（开颅术后清除血肿并进行外部减压）。两个病例术后均取得了良好的效果。病例1为一名36岁女性。患者入院时的意识水平为GCS 3分。根据CT检查结果，从受伤到确诊的时间间隔为75分钟。确诊后20分钟开始手术。病例2为一名25岁男性。第二名患者入院时的意识水平为GCS 4分。根据CT检查结果，从受伤到确诊的时间间隔为60分钟。确诊后40分钟开始手术。两名患者均出现瞳孔不等大及光反射消失。然而，术后恢复过程良好，两名患者均已出院。总之，对于治疗严重急性硬膜下血肿，早期紧急去骨瓣减压术是最佳选择。急诊室的紧急减压手术不依赖手术室或工作人员。因此，紧急去骨瓣减压术可能会改善严重急性硬膜下血肿患者的预后。
