Ito H, Shimoji T, Kimura M, Maeda M, Uehara S, Yamamoto S
No Shinkei Geka. 1984 Apr;12(5):563-8.
Mean quantity of daily hemorrhage into the hematoma cavity was determined at the craniotomy in 39 cases with chronic subdural hematoma. Mean daily hemorrhage amounted 6.7 per cent of hematoma volume. Those in infancy, adults younger or older than 70 years old were 6.8%, 6.9% and 6.2%, respectively. When the period from head trauma till the craniotomy was less 3 months, one fourth of cases showed more bleeding than 10% of hematoma content into the cavity. Over 3 months after the head trauma, hemorrhage decreased in volume, amounted less than 2%. The severer the clinical grading of chronic subdural hematoma was, the more the daily hemorrhage was. The cases with dementia demonstrated usually less hemorrhage. The daily hemorrhage into the hematoma cavity did not correlate clearly with the maximum breadth of subdural hematoma in CT scans or carotid angiograms. Not only bleeding but also its dilution and condensation in the subdural hematoma modifies the density of hematoma cavity in CT scans. There were many cases showing more hemorrhage at FDP levels among 320 and 640 micrograms/ml. The hemorrhage into the chronic subdural hematoma cavity is caused by imbalance of local hyper-fibrinolysis and coagulability and daily hemorrhage amounts 6.7% of hematoma content. Such interrupted or continuous hemorrhage results in aggravation of clinical symptoms and high density of hematoma space in CT scans.
在39例慢性硬膜下血肿患者开颅手术时测定了血肿腔内每日的平均出血量。平均每日出血量占血肿体积的6.7%。婴儿、70岁以下及70岁以上成人的这一比例分别为6.8%、6.9%和6.2%。头部外伤至开颅手术的时间小于3个月时,四分之一的病例血肿腔内出血量超过血肿内容物的10%。头部外伤3个月后,出血量减少,少于2%。慢性硬膜下血肿的临床分级越严重,每日出血量越多。痴呆患者的出血量通常较少。血肿腔内的每日出血量与CT扫描或颈动脉血管造影中硬膜下血肿的最大宽度无明显相关性。硬膜下血肿内不仅有出血,而且其稀释和浓缩也会改变CT扫描中血肿腔的密度。在320至640微克/毫升的纤维蛋白溶解酶原水平下,有许多病例显示出血较多。慢性硬膜下血肿腔内出血是由局部高纤维蛋白溶解与凝血功能失衡引起的,每日出血量占血肿内容物的6.7%。这种间断或持续的出血导致临床症状加重以及CT扫描中血肿腔密度增高。