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頁籤選單縮合
題名 | Experience in Conservative Treatment of Epidural Hematoma=對硬腦膜上血腫病例做保守治療的經驗 |
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作者姓名(中文) | 曾勝弘; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 21:6 1988.11[民77.11] |
頁次 | 頁705-711 |
分類號 | 416.291 |
關鍵詞 | 硬腦膜上血腫; 保守治療; |
語文 | 英文(English) |
中文摘要 | 硬腦膜上血腫通常是神經外科的急症,傳統的治療是立即施行手術,清除血塊,若有所延誤,可能會造成嚴重的後遺症,甚至危及生命。但是對於某些臨床狀況良好的病人,我們可以嘗試做保守的治療。自1981年1月至1985年12月,5年期間共有13位硬腦膜上血 腫病例接受保守治療。其年齡分佈自8歲至52歲,平均28歲。男性有9位,女性有4位。這些病例被送到醫院時,只有輕微的神經症狀或完全沒有症狀;其意識程度則是清醒或逐漸進步,其他一般情況良好。所有病例在受傷後l小時至10天內接受電腦斷層檢查而被發現有硬腦膜上血腫;同時我們利用電腦斷層估計其血塊的大小,自約7 ml至約47 ml,平均約23.7 ml。所有病人均接受保守治療,主要處理方法為密切觀察,定期的神經學檢查及藥物治療。在住院期間,每一位病人的臨床狀況都逐漸地進步。症狀在受傷後2天至22天(平均13天)內完全消失。所有病例的復原情況都良好。6位病例在受傷後1至3星期接受1次電腦斷層追踪檢查,發現血塊已部分吸收,另有一病例接受2次電腦斷層追踪檢查,血塊在受傷後8星期完全吸收。所有病例均接受追踪檢查,自2.5月至4年8個月,平均2年9個月,目前情況都非常良好。所以對於罹患有較小的硬腦膜上血腫而無明顯神經症狀的病例,經過謹慎的選擇,可以嘗試保守治療,但必須嚴密觀察病情及追踪,而且一旦情況惡化,必須能立刻獲得手術治療。但是除了這些特殊病例外,原則上,大部份硬腦膜上血腫病人須接受手術治療。 |
英文摘要 | During the 5-year period frorn January 1981 to Decernber 1985, 13 patients with epidural hernatorna (EDH) were treated conservatively. These patients initially had no, or only mild, neurological signs. Consciousness was either clear or steadily improving at the tirne of exarnination. Computed tomography (CT) was perforrned in each case and dernonstrated the EDH 1 hour to 10 days after head njury. The CTestirnated arnount of EDH ranged frorn about 7 to 47 ml. All patients were treated conservatively and made a comlpete neurological recovery. Six patients, one to three weeks after injuries, underwent a follow-up CT examination which revealed partial resolution of the hematoma; another patient underwent two follow-up CT exarninations which revealed complete resolution of the hematoma eight weeks after the head injury. All but one patient were followed up for 2 1/2 months to 4 2/3 years; they are doing well up to the time of this report. Conservative managernent, after careful selectiion, seems appropriate for patients with a small EDH and without significant neurological signs, but they should be followed by close observation, and surgical intervention should be readily available should the condition deteriorate. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。