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Objective:To explore the risk factors of delayed traumatic intracranial hematoma (DTICH)followed by unilateral large decompressive craniectomy (LDC)and its influence in the prognosis of the severe traumatic brain injury (sTBI)patients,and to improve the successful rate of the rescue.Methods:The clinical data of 130 sTBI patients underwent unilateral LDC were retrospectively analyzed.The patients were divided into DTICH group (n=42)and non-DTICH group (n=88)according to whether the DTICH occurred after operation.The risk factors of DTICH and its influence were contrastively analyzed.Results:The analysis results of the clinical data of patients in two groups showed that preoperative GCS,time from trauma to operation,skull fracture,midline shift > 1 cm, basal cistern disappear,activated partial prothrombin time (APTT),fibrinogen (FIB),and thrombin time (TT) were significantly correlated with the appearance of DTICH (P<0.05).Multivariable Logistic regression analysis showed that the time from trauma to operation, skull fracture, basal cistern disappearing and FIB were the independent risk factors of DTICH (P<0.05).The analysis results of GOS 3 months after operation of the patients in two groups showed that the prognosis of the patients in DTICH group was significantly worse than that in non-DTICH group (P<0.01 ).Conclusion:For those patients who accompanied with shorter time from trauma to operation,skull fracture,basal cistern disappearing and FIB decrease,the appearance of DTICH should be paid attention.DTICH can affect the prognosis of patients;prevention and early diagnosis are crucial to improve the prognosis of patients.
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Objective To explore the effective method in treatment of traumatic intracranial hematoma.Methods The measures and effects of traumatic intracranial hematoma treated by combined treatment of traditional Chinese medicine and western medicine were retorspectively analyzed. 62 cases with traumatic intracranial hematoma were taken controlled methods of clinical research: the control group had 30 patients ( received Western medicine),and experimental group had 32 cases ( received Western medicine treatment combined with Chinese medicine Qingkailing or/and Ligustrazine at the same time ), therapeutic effect evaluation was mede after 28 days.Results Clinical results of the experimental group was superior than the control group ( P ＜ 0.05 ); and complications were fewer (P ＜ 0.05). Conclusion Integration of Chinese and western medicine could improve the efficacy of traumatic intracranial hematoma.
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Objective To evaluate the value of minimally invasive technique in treatment of severe traumatic intracranial hematoma at emergency department.Method From January 1995 to December 2005,126 patients were treated by using the minimally invasive technique in Affiliated Chaoyang hospital once patients were diagnosedas severe traumatic cerebral hernia resulted from intracranial hematoma and also those whose clinical data were retrospectively analyzed.In the emergency department,the per-operative plan was done according to the CT imaging,including the sute of burr hole on the skull,the direction and depth of carmulation,and the drainage cannula was put into the hematoma cavity for external drainage under local anesthesia.Results The successful rate of puncture was 100%.The patients's dukated oyouk contracted immediately after drainage.There are 79/ 95 patients(83.1%)had single pupil dilated and 17/31(54.8%)patients had bilateral pupils dilated.The immediately clinical effective was 76.2%.According to Glasgow outcome scale,43 of 126 patients had good recovery,26 had moderate deficits and 18 had severe sequelae,16 patients were in vegetative state,18 died. Conclusions Clinical prospective study proves that minimally invasive technique can ameliorate the cerebral hernia,prolong the operative therapie window time.
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This paper presents 332 cases of traumatic intracranial hematoma treated at Shenyang command general hospital during the period from October 1980 to October 1987. Among them, 111 cases had brain hernia at the time of admission. The overall mortality was 16.9%, of which 'supra-acute type' (brain hernia occurred within 3 hours after trauma) was 57.1%, acute type 9.3%, and subacute type was zero. The mortality of epidural, subdural, intracerebral, multiple and intraventricular hematoma, were 3.8%, 39.1%. 7.5%, 27.9% and 50%, respectively. The authors believe that CT scan playsa decisive role in the diagnosis of intraventricular, intracerebellar, and basal ganglionic hemaloma, since without CT it can not be diagnosed. In addition, the authors hold that successive observation of patients with CT scans is also of utmost importance, particularly for those with delayed and multiple he-matomas. Furthermore, take every measures to prevent complications and adequate management of brain iniury itself were other two factors in decreasing the mortality of traumatic intracranial hematoma.