[慢性硬膜下血肿与年龄相关的促发因素]

[Promotive factors of chronic subdural hematoma in relation to age].

作者信息

Yamazaki Y, Tachibana S, Kitahara Y, Ohwada T

机构信息

Department of Neurosurgery, Kitasato University School of Medicine.

出版信息

No Shinkei Geka. 1996 Jan;24(1):47-51.

PMID:8559264

Abstract

To reveal the pathogenesis of chronic subdural hematoma (CSDH), 256 patients with CSDH over 1 year of age were studied in relation to various traumatic or nontraumatic promotive factors of CSDH including arachnoid cyst, implantation of a cerebrospinal fluid shunt, secondary cerebral atrophy, coagulopathies and past history of acute subdural hematoma or effusion. All patients were grouped according to decade of age. The incidences of associated promotive factors were individually analyzed in each group. The incidences of associated promotive factors in the 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th decades of life were 71%, 89%, 56%, 33%, 9%, 11%, 8%, 8% and 5%, respectively. Thus, they were divided into two groups; youth (1st to 4th decade: n = 34) and elder (5th to 9th decade: n = 222). The incidences of associated promotive factors were 62% and 8%, respectively (P < 0.001). Severity of head injury received was also evaluated in these two groups. In the youth group, 15 out of 34 patients (44.1%) had received severe head injuries with loss of consciousness, while in the elder group, only 22 out of 222 patients (9.9%) had received severe head injuries (P < 0.001). The analysis was repeated after each group was divided into two subgroups regarding the coexistence of promotive factors. Among the youth group, 13 patients had no promotive factors and 21 had one or more promotive factors. In those without any promotive factor, 9 out of 13 had received severe head injuries with loss of consciousness, while in those with promotive factors, 6 out of 21 had received severe head injuries. On the other hand, majority of the elder group had not received severe head injuries irrespective of whether patients had promotive factors or not. The present study revealed that majority of young CSDH patient had some promotive factors or severe head injuries with loss of consciousness, and that majority of patients aged over 40 years had no promotive factors and did not receive severe head injuries.

摘要

为揭示慢性硬膜下血肿（CSDH）的发病机制，对256例1岁以上的CSDH患者进行了研究，分析了包括蛛网膜囊肿、脑脊液分流管植入、继发性脑萎缩、凝血功能障碍以及急性硬膜下血肿或积液病史等各种创伤性或非创伤性促发因素。所有患者按年龄十年分组。对每组中相关促发因素的发生率进行单独分析。在10岁、20岁、30岁、40岁、50岁、60岁、70岁、80岁、90岁年龄段患者中，相关促发因素的发生率分别为71%、89%、56%、33%、9%、11%、8%、8%和5%。因此，将患者分为两组：青年组（10岁至40岁：n = 34）和老年组（50岁至90岁：n = 222）。相关促发因素的发生率分别为62%和8%（P < 0.001）。还对这两组患者所遭受的头部损伤严重程度进行了评估。在青年组中，34例患者中有15例（44.1%）遭受了导致意识丧失的严重头部损伤，而在老年组中，222例患者中只有22例（9.9%）遭受了严重头部损伤（P < 0.001）。在每组根据促发因素的共存情况分为两个亚组后，重复进行分析。在青年组中，13例患者无促发因素，21例有一个或多个促发因素。在无任何促发因素的患者中，13例中有9例遭受了导致意识丧失的严重头部损伤，而在有促发因素的患者中，21例中有6例遭受了严重头部损伤。另一方面，老年组中的大多数患者无论是否有促发因素均未遭受严重头部损伤。本研究表明，大多数年轻的CSDH患者有一些促发因素或遭受了导致意识丧失的严重头部损伤，而大多数40岁以上的患者没有促发因素且未遭受严重头部损伤。