Shigemori M, Tokutomi T, Yuge T, Shojima K, Matsuo H, Moriyama T, Kuramoto S
Department of Neurosurgery, Kurume University School of Medicine, Japan.
No Shinkei Geka. 1987 Dec;15(12):1305-10.
In order to clarify the present problems in the treatment of acute subdural hematoma with low GCS score (5 or less), we studied the difference of the outcomes from two different surgical treatments for these patients. The present series included 30 patients who had GCS scores of 3, 4 or 5, and they were divided into two groups: 16 in DH group who had decompressive hemicraniectomy and 14 in HITT group who had hematoma irrigation with trephination therapy. The mean age of the patients was 47 years. They all had an intensive medical management including barbiturate therapy under intracranial pressure (ICP) monitoring after the operation. Time course of ICP after operation was classified as controlled, high but reduced and uncontrollable, based on the ICP level of 30 mmHg. The outcomes of the patients were determined by use of Glasgow outcome scale and classified into good, poor and dead. In these patients, the outcome was good in 13.3%, poor in 23.3% and dead in 63.4%. There was no survived case in those with GCS score of 3. The mortality rate in older patients over 60 years was high as 81.8%. ICP was well controlled in 2 patients (12.4%) in DH group. But there is no such case in HITT group. Uncontrollable ICP was more frequently seen in HITT group than in DH group. The patients showed different outcomes in the two types of treatment. Good outcome was found in 18.7% and the mortality rate was 56.3% in DH group. On the other hand, only one patient (7.1%) showed good outcome and the mortality rate of 71.4% in HITT group.(ABSTRACT TRUNCATED AT 250 WORDS)
为了阐明目前低格拉斯哥昏迷量表（GCS）评分（5分及以下）的急性硬膜下血肿治疗中存在的问题，我们研究了这些患者两种不同手术治疗的预后差异。本系列包括30例GCS评分为3、4或5分的患者，他们被分为两组：16例在去骨瓣减压术（DH）组，14例在钻孔冲洗引流术（HITT）组。患者的平均年龄为47岁。术后他们均接受了包括在颅内压（ICP）监测下进行巴比妥类药物治疗的强化医疗管理。根据ICP水平30 mmHg，将术后ICP的时间进程分为可控、高但降低和不可控。患者的预后通过格拉斯哥预后量表确定，并分为良好、不良和死亡。在这些患者中，预后良好的占13.3%，不良的占23.3%，死亡的占63.4%。GCS评分为3分的患者无一存活。60岁以上老年患者的死亡率高达81.8%。DH组有2例患者（12.4%）ICP得到良好控制。但HITT组没有这种情况。HITT组不可控ICP的发生率比DH组更高。两种治疗方式患者的预后不同。DH组良好预后率为18.7%，死亡率为56.3%。另一方面，HITT组只有1例患者（7.1%）预后良好，死亡率为71.4%。（摘要截断于250字）
