Schröder M L, Muizelaar J P, Kuta A J
Division of Neurosurgery, Medical College of Virginia, Virginia Commonwealth University, Richmond.
J Neurosurg. 1994 Feb;80(2):324-7. doi: 10.3171/jns.1994.80.2.0324.
The authors report two cases of severe head injury with acute subdural hematoma, in which cerebral blood flow (CBF) and cerebral blood volume (CBV) measurements were obtained prior to evacuation of the subdural hematoma and again immediately after removal. The first patient, a 21-year-old man with a motor response localizing to pain, had a global CBF of 18.2 ml/100 gm/min and a decreased global CBV of 3.7 ml/100 gm at 2.3 hours after injury. Immediately after removal of the subdural hematoma (8.1 hours after injury), CBF and CBV measurements revealed increases to 35.5 ml/100 gm/min and 5.8 ml/100 gm, respectively. The second patient, a 49-year-old woman with a normal flexor motor response to pain, had preoperative global values of 15.8 ml/100 gm/min for CBF and 2.0 ml/100 gm for CBV at 3 hours after injury. Postoperatively (9.3 hours after injury), the CBF and CBV values increased to 41.6 ml/100 gm/min and 4.0 ml/100 gm, respectively. The first patient, with only borderline ischemia and removal of the subdural hematoma within 3 hours, made a good recovery, while the second patient, with prolonged lower levels of CBF, remained in a persistent vegetative state. The low values of preoperative CBV argue for compression of the microcirculation as the cause of ischemia.
作者报告了两例严重颅脑损伤伴急性硬膜下血肿的病例，在硬膜下血肿清除术前及清除后立即测量了脑血流量（CBF）和脑血容量（CBV）。首例患者为一名21岁男性，对疼痛有定位性运动反应，伤后2.3小时全脑CBF为18.2 ml/100 gm/min，全脑CBV降低至3.7 ml/100 gm。硬膜下血肿清除后即刻（伤后8.1小时），CBF和CBV测量显示分别增至35.5 ml/100 gm/min和5.8 ml/100 gm。第二例患者为一名49岁女性，对疼痛有正常的屈肌运动反应，伤后3小时术前全脑CBF值为15.8 ml/100 gm/min，CBV为2.0 ml/100 gm。术后（伤后9.3小时），CBF和CBV值分别增至41.6 ml/100 gm/min和4.0 ml/100 gm。首例患者仅有临界性缺血且在3小时内清除了硬膜下血肿，恢复良好，而第二例患者CBF持续处于较低水平，仍处于持续性植物状态。术前CBV值较低表明微循环受压是缺血的原因。
