Sakas D E, Bullock M R, Teasdale G M
Department of Neurosurgery, University of Glasgow, Scotland.
J Neurosurg. 1995 Jun;82(6):961-5. doi: 10.3171/jns.1995.82.6.0961.
Forty consecutive patients who underwent craniotomy for traumatic hematoma after developing bilateral fixed dilated pupils were studied to determine the factors influencing quality of survival and to seek criteria for management. Clinical and computerized tomography (CT) data were correlated with outcome 1 year after craniotomy. The functional recovery (good outcome or moderate disability) rate was 25%, with a mortality rate of 43%. Patients with subdural hematoma had a higher mortality rate (64%) compared to patients with extradural hematoma (18%) (chi-square test, p > 0.05). Other factors associated with markedly increased morbidity and mortality were increasing age (> 20 years), a prolonged interval (> 3 hours) between loss of pupillary reactivity and craniotomy, compression of basal cisterns, and presence of subarachnoid hemorrhage on CT. There were no survivors among patients exhibiting any of the following features: surgery 6 hours or more after bilateral loss of pupillary reactivity; age greater than 65 years; or absent motor response. Apart from the latter group, the nature of motor response (before pharmacological paralysis and intubation) was not a reliable predictor of mortality. The results suggest that the presence of an acute subdural hematoma is the single most important predictor of negative outcome in patients with bilateral unresponsive pupils.
对40例双侧瞳孔固定散大后因创伤性血肿接受开颅手术的连续患者进行研究，以确定影响生存质量的因素并寻找治疗标准。将临床和计算机断层扫描（CT）数据与开颅术后1年的结果相关联。功能恢复（良好结果或中度残疾）率为25%，死亡率为43%。与硬膜外血肿患者（18%）相比，硬膜下血肿患者的死亡率更高（64%）（卡方检验，p>0.05）。与发病率和死亡率显著增加相关的其他因素包括年龄增加（>20岁）、瞳孔反应丧失与开颅手术之间的间隔延长（>3小时）、基底池受压以及CT上存在蛛网膜下腔出血。出现以下任何一种特征的患者均无幸存者：双侧瞳孔反应丧失后6小时或更长时间进行手术；年龄大于65岁；或无运动反应。除后一组外，运动反应的性质（在药物性麻痹和插管之前）并非死亡率的可靠预测指标。结果表明，急性硬膜下血肿的存在是双侧无反应性瞳孔患者不良结局的最重要单一预测指标。
