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題名 | Factors Influencing the Outcome of Patients with Acute Epidural Hematoma=急性硬腦膜上血腫--與預後有關之因素的探討 |
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作者 | 吳朝宗; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 28:6 民84.11-12 |
頁次 | 頁477-485 |
分類號 | 416.291 |
關鍵詞 | 急性硬腦膜上血腫; Epidural hematoma; Glasgow coma scale; Mortality; Outcome; Motor score; |
語文 | 英文(English) |
中文摘要 | 急性硬腦膜上血腫是頭部外傷領域中的急症,常常會有很戲劇性的變化,可能會由一個沒有一點症狀的病人一下子變成昏迷狀態,其變化有時候會快得讓你措手不及而來不及救他。遇到這種病人,最迫切需要的是早期發現與早期開刀治療,才能得到滿意的結果。否則稍有耽擱,可能就會引起嚴重的後遺位或死亡。自一九八一年八月至一九九三年五月,我們收集在本院入院治療的162位硬腦膜上血腫病患。其總死亡率為11.1%,另外有1.9%變成植物人或需要長期受照顧的病患。總共162病例中,有141位接受開刀治療,手術死亡率為12%,有86%可得到滿意的結果。但是有51位病人(36.2 %)在開刀前已呈深度昏迷狀態,其死亡率高達25.5%。 經過我們分析141位因硬腦膜上血腫接受開刀的病例,發現與其預後有息息相關的因素有下列幾項:開刀前的格位斯哥昏述度或運動度、開刀前的瞳孔變化、血腫的大小以及有沒有其他顱內病變等。其中以運動度來預測其預後最為準確。 有關開刀的緊急度問題,我們發現五個小時內接受手術的病例其死亡率為13.6%,而五至十二小時內手術者為11.8%,但是超過十二小時再開刀的則降為4.8%。所以需要在短時間內接受開刀的病例其死亡率較高,而這些病例據分析有下列幾個特性:格拉斯哥昏迷度或運動度較低、瞳孔變化較大、血塊較大且中間線偏離明顯者。所以當血塊形成較快時,有可能造成無法避免的死亡。 在141未接受開刀的病例中有26例(18.4%)同時還擁有一至多種其他顱內病變,例如腦挫傷、腦內出血、硬腦膜下血腫或廣泛性神經軸索受傷等。這些病人手術後的死亡率為19.2%,高出一般病人很多。而且這種病人因有腦腫漲,會使對於血塊的忍受度變低,將使需要開刀的緊急度變高,或迫使小血塊病人接受開刀治療。 當一個病人的硬腦膜上血腫小於20 ml,沒有其他顱內病變,而且神智清楚時,可以考慮給予做保守治療。 |
英文摘要 | An unselected, consecutive series of 162 patients with epidural hematoma (EDH), treated in this clinic between Angust 1981 and May 1993, is reviewed. The overall mortality was 11.1%, with 1.9% having severe disability or remaining in a vegetative state. Among the 162 cases of EDH, 141 cases received surgical treatment. The surgical mortality was 12%; 86% made a functional recovery. There were 51 patients (36.2%) in deep coma before operation, and their mortality was 25.5%. A correlation was found between the final result and preoperative Glasgow coma scale (GCS) score or motor score and preoperative pupil sign, the size of the hematoma and associated intracranial lesions. Among these, the motor score immediatly before operation was the most important preoperative predictor of outcome. The mortality rate was higher in patients operated on within 5 hours (13.6% mortality) and from 5 to 12 hours (11.8% mortality) of arrival than in those undergoing surgery 12 or more hours after arrival (4.8% mortality). Compared with the patients operated on later, the patients undergoing surgery in the early period had, on the average, lower motor scores, more pupillary changes, a larger volume of hematoma and more midline shifting. In those patients, it is possible that a rapidly developing EDH contributed to a higher mortality. For total cases of EDH who had received craniotomy, 18.4% had one or more associated intracranial lesions and their mortality was 19.2%. Hence associated intracranial lesions may adversly affect the final outcome. The existence of associated intracranial lesions may also decrease the tolerance of the brain to the presence of EDH and necessitate early operation or operation for small EDH. Patients with small EDH (below 20 ml in size) and without associated intracranial lesion, plus clear or steadily improving conscious level may be treated conservatively. |
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