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目的 :探讨外伤性蛛网膜下腔出血 (tSAH)后难治性硬膜积液的成因及病理生理变化。方法 :回顾分析 5 8例tSAH并硬膜下积液 (traumasubduralfluidcollection ,tSFC)病例。其中积液自行吸收与钻孔引流吸收共 36例 ,为简单tSFC ,设为对照组 ;上述治疗无效 ,积液持续 >30d 2 2例 ,为难治性tSFC组。结果 :难治性tSFC组后期均伴有脑室扩大 (10 0 % ) ,18例 (82 % )需要行侧脑室腹腔分流术 (VP shunt)。难治性tSFC行VP需与简单tSFC行需VP百分率比较 ,差异有显著意义 (P <0 0 1) ,提示 :脑脊液动力学障碍与难治性tSFC有一定联系。 18例难治性tSFC行VP后 ,脑室缩小 ,tSFC随之吸收。结论 :tSAH后难治性tSFC是脑外积水而非简单tSFC ,脑脊液吸收障碍与外伤性蛛网膜裂孔是其成因。
Objective: To investigate the causes and pathophysiological changes of refractory dura mater after traumatic subarachnoid hemorrhage (tSAH). Methods: Fifty-eight cases of tSAH with traumatic subdural fluid collection (tSFC) were retrospectively analyzed. 36 cases of spontaneous absorption of effusion and drainage and drainage of a total of simple tSFC, as the control group; the above treatment was ineffective, fluid retention> 30d2 2 cases, refractory tSFC group. Results: Ventricular enlargement (100%) occurred in the later stage of refractory tSFC. VP shunt was required in 18 cases (82%). VP of refractory tSFC patients need VP percentage compared with simple tSFC patients, the difference was significant (P <0.01), suggesting that: cerebrospinal fluid dynamics disorders and refractory tSFC have a certain connection. 18 cases of refractory tSFC line VP, ventricular contraction, tSFC subsequently absorbed. CONCLUSION: Refractory tSFC after tSAH is a cause of hydrocephalus rather than simple tSFC, cerebrospinal fluid imbalance and traumatic arachnoid hiatus.