钻孔引流术治疗慢性硬膜下血肿合并急性出血的疗效分析

目的探讨慢性硬膜下血肿合并急性出血（acSDH）的临床特点及钻孔引流术疗效。方法回顾性分析2019年4月—2022年12月上海交通大学医学院附属仁济医院通过手术治疗的185例慢性硬膜下血肿（CSDH）患者的临床资料，收集其中的22例acSDH病例并总结其临床特点，分析钻孔引流术对acSDH的疗效。结果acSDH发病率约占同期CSDH的11.89%，和同期收治的不伴急性出血的CSDH患者比较，acSDH患者具有入院格拉斯哥昏迷评分（GCS）低、血肿厚度大、血肿计算机断层扫描(CT)值高的特点（均P＜0.05）。钻孔引流术治疗acSDH在引流管留置时间、总住院时间、出院时改良Rankin 量表(mRS)、3个月内再出血率、复发率和随访1年死亡率方面，和不伴急性出血的CSDH患者比较无显著差异（均P＞0.05），而在尿激酶使用次数、术后颅内出血发生率方面两者差异显著（均P＜0.05）。结论acSDH是CSDH特殊类型。钻孔引流配合尿激酶使用是临床治疗acSDH的有效方式。

Objective To explore the clinical characteristics and burr-hole drainage efficacy of the patients with acute-on-chronical subdural hematoma(acSDH). Methods The clinical data of 185 patients with chronical subdural hematoma(CSDH) admitted to Renji Hospital, School of Medicine, Shanghai Jiao Tong University from April 2019 to December 2022 were analyzed retrospectively. The clinical characteristics and burr-hole drainage efficacy of 22 acSDH patients were analyzed. Results The incidence rate of acSDH was 11.89%. Compared with patients of CSDH without acute hemorrhage, the acSDH patients had clinical characteristics of lower admitting Glasgow coma scale(GCS), larger hematoma thickness and higher hematoma computer tomography(CT) score(all P＜0.05). There was no significant difference about duration of drainage, hospitalization time, modified Rankin Scale(mRS) of discharge, 3-month rebleeding rate, recurrence of reoperation rate and 1-year follow-up mortality(all P＞0.05). However, there was significant difference about frequency of using urokinase and occurring complication of post-operation cranial hemorrhage between groups with or without acute hemorrhage（both P＞0.05）. Conclusions acSDH is a special type of CSDH. Burr-hole drainage with using urokinase is an effective therapeutic method for treating acSDH.