慢性硬膜下血腫相關因素的臨床分析

劉旭峰　趙云鶴　楊桂姣

[摘要] 目的 探討慢性硬膜下血腫的臨床特征及其診治。 方法 對2013年7月～2016年10月山西大同第五人民醫院收治的98例慢性硬膜下血腫患者的臨床資料進行回顧性分析。 結果 慢性硬膜下血腫患者以老年人多見，且男性明顯多于女性。男性和女性之間臨床癥狀、治療方法及預后效果比較均無明顯差異（P>0.05）。男女不同年齡段之間比較發現：在男性患者中70歲及以上者高血壓和腦萎縮發生率較70歲以下者高（P=0.005，P=0.001），70歲以下者糖尿病發生率較70歲及以上者高（P=0.049）；而在女性患者中70歲以上者腦萎縮發生率較高（P=0.036）。臨床表現以頭昏頭痛、肢體活動障礙、言語功能障礙、視物模糊和精神癥狀為主，男性患者中70歲及以上者語言障礙和肢體活動障礙發生率較70歲以下者高（P=0.043，P<0.001）；女性患者中各種伴發癥狀發生率在兩個年齡段間比較未見明顯差異（P>0.05）。治療效果觀察：男性患者手術治療效果明顯優于保守治療（P<0.05）；女性患者兩種治療效果無明顯差異（P>0.05）。 結論 對高危人群應警惕對待臨床癥狀，做好早發現、早診斷和正確治療。

[關鍵詞] 慢性硬膜下血腫；診斷；治療

[中圖分類號] R651.15 [文獻標識碼] A [文章編號] 1673-9701（2017）12-0013-04

[Abstract] Objective To investigate the clinical characteristics， diagnosis and treatment of chronic subdural hematoma. Methods The clinical data of 98 patients with chronic subdural hematoma from July 2013 to October 2016 in Shanxi Datong Fifth People's Hospital were analyzed retrospectively. Results Chronic subdural hematoma was more common in the elderly， and the chronic subdural hematoma in male was significantly more than that of the female. There were no significant differences in clinical symptoms， treatment methods and prognosis between the male and female（P>0.05）. By comparing men and women of different age groups， it was found that the incidences of hypertension and brain atrophy of patients ≥70 years old was higher than those in patients below 70 years old（P=0.005， P=0.001）， while the incidence of diabetes mellitus in patients below 70 years old was higher than that in patients ≥70 years old（P=0.049）. And the incidence of brain atrophy was higher in women ≥70 years old（P=0.036）. The clinical manifestations were mainly dizziness， headache， limb mobility disorders， speech dysfunction， blurred vision and psychiatric symptoms， and the incidences of physical disorders and physical activity were higher in male patients over 70 years than those in patients below 70 years old（P=0.043， P<0.001）. There was no significant difference between the two age groups in female patients（P>0.05）. Treatment effect observation： The effect of surgical treatment was significantly better than that of conservative treatment in male patients （P<0.05）. There was no significant difference between the two treatments in female patients （P>0.05）. Conclusion High-risk groups should be vigilant to clinical symptoms to ensure early detection， early diagnosis and correct treatment.

[Key words] Chronic subdural hematoma； Diagnosis； Treatment

慢性硬膜下血腫（chronic subdural hematoma，CSDH）是指一種具有包膜的血腫，位于蛛網膜與硬腦膜之間，常于創傷后3周出現癥狀，有時病程更長，甚至半年之久。且多數患者常無明確外傷史，可能與起病隱匿、無明顯臨床特征有關。經統計，慢性硬膜下血腫的發生率占顱內血腫的10%，占硬膜下血腫的25%[1]。通常依靠CT或者MRI可以作出診斷[2]。

隨著我國人口老齡化日益嚴重，交通事故多發，人們對疾病的警惕性增高，越來越多的CSDH在臨床上被發現。C……