Translated Abstract
Background and purpose:
Acute epidural hematoma that occurred in between the dura and the skull plate hematoma, traumatic intracranial hematoma accounts for 20-30%; the incidence of closed head injury can account for 2.5-3.5% of its after the incidence of acute subdural hematoma. Traumatic epidural hematoma is common in acute or acute onset special, the incidence rate of about 85%, subacute hematoma incidence of 11%, about 4% of those with chronic, rare. Multiple epidural hematoma is rare, usually solitary, but can be combined with other types of hematoma in the subdural hematoma combined hedge positions more common. Acute epidural hematoma can lead to brain herniation in patients with massive cerebral infarction and cerebral edema, seriously endanger the lives and safety of patients.
Typical acute epidural hematoma is more common in young males linear fracture patients, most commonly occur in the frontal and temporal top of the site, the meninges of the temporal artery, vein, when the fracture is easily torn, especially the rapid development epidural hematoma, where more blood from the hematoma artery injury, the rapid increase of the hematoma, a short time can lead to brain herniation occurs, the patient lives are at stake. If the hematoma blood from the vein, or vein diploic dural venous sinus and progression of the disease is generally not in a hurry, for subacute or chronic condition. Less acute epidural hematoma occurred in the occipital. When the fracture line through the transverse sinus and superior sagittal sinus, there will be ride on a huge epidural hematoma on the sinus, hematoma constantly increasing, after stripping the dura and the bone plate can be caused by bleeding, and not only because the venous pressure caused by continued bleeding. Hematoma volume size relationship between the severity of the disease and more closely, the greater the hematoma, the disease will be more severe. Bleeding speed will become more ferocious. Acute hematoma hemisphere convex position on pushing down and the brain tissue is often upward direction, eventually the hippocampus and medial temporal lobe hook back suddenly to tentorial less oppression in the brain, oculomotor nerve, brain artery , midbrain, pons and affect sinus venous reflux rock, called tentorial hernia. Usually the source of bleeding hematoma: Sources traumatic epidural hematoma, mainly seen in the following vascular injury, due to the small number of blood components change. The most common source of bleeding is the middle meningeal artery. Secondly venous sinus injury, skull fracture midline sagittal sinus can cause damage due to the transverse sinus damage is caused by efforts to occipital linear fracture. And former meningeal artery and arterial sieve plates or guide impaired venous blood vessels, blood vessels and other small dural injury.
Today, the risk of cardiovascular disease will cause some brain symptoms occur, such a situation present a rising trend, this study is acute epidural hematoma causing herniation in patients with massive cerebral infarction, cerebral edema Related research and analysis of risk factors, pathology and physiology research reasons for its symptoms, which helps improve clinician acute epidural hematoma causing herniation in patients with massive cerebral infarction, cerebral edema of the reasons to be understanding, to take effective measures its prevention and treatment, reduce the incidence of the disease, improve the survival rate, greatly improve the quality of life of patients. To prevent further deterioration of the disease. And in patients with acute epidural hematoma caused by a large area of cerebral herniation, clinical symptoms of cerebral edema, prognosis and predictive value were discussed, can be detected fibrinolytic and coagulation functions.
Methods:
260 cases of acute subdural hematoma were selected in October 2013 to October 2015 in our hospital for treatment, it was set to study and collect the clinical data of these patients to be analyzed and studied. (1) design a questionnaire for collecting the patient＇s gender, age, reason for treatment, diagnosis, treatment and treatment results, etc., acute subdural hematoma be analyzed and viewed in different gender, the distribution of different ages, subdural analysis memory treatment of cerebral infarction and cerebral edema causes and diagnosis of pathological and physiological type of hernia patients hematomas occur [1]. (2) In addition to occupation, marital status, education, household economic conditions, the nutritional status of the patient, drinking, smoking and sleeping status survey, by clinical examination and laboratory examinations, to understand the extent of comatose patients, time of onset, clinical symptoms, treatment and the degree of recovery and other information. Found that these patients were divided into non-delayed and delayed hematoma, hematoma in patients with late-onset, 68 cases of non-delayed hematoma in patients with 192 cases, the non-delayed hematoma occurred in situ, depending on whether the patient divided into a control group and relapse group, the average number of each group of 96 patients; these patients were divided into two groups, namely the control and test groups, due to acute epidural hematoma caused by cerebral herniation and cerebral edema occur recorded as the test group, the number of 80 cases of acute epidural hematoma without herniation and cerebral infarction, cerebral edema referred to as the control group, the number is 180 cases, followed by analysis of variance test and single factor of quantitative data separately and qualitative analysis of the data of two ounces of compare the two, between the two groups of data were compared using non-parametric test or T-test, and then use the Logistic regression model delayed hematoma patient data analysis will further appear the analysis and study of adverse factors and risk factors of hematoma, multivariate Logistic analysis [2], such as acute epidural hematoma causing herniation large area cerebral infarction, cerebral edema associated risk factors predictive value of evaluation need to adopt patients receiving operating characteristic curve (Receiver Operating Characteristic, ROC) were measured [11-12]. Acute epidural hematoma causing herniation large area cerebral infarction, cerebral edema in patients hospitalized with immediate effect, to measure their vital signs of patients with blood clotting and heart series EEG detection using immunoassay technical its D- dimer (DD), Von Willebrand Factor (VWF) and Thrombomodulin (TM) detection [3]. Finally, surveys and statistics can be made to the patient＇s medical history, disease history, etc., pairwise comparison between data based on the results of these assays to determine the acute epidural hematoma caused by cerebral herniation and cerebral edema occur in high-risk factors, the current study on high factors, it is considered with the patient＇s age, sex, blood glucose level, systolic blood pressure, the improper operation and other factors on acute epidural hematoma surgery appears in [4].
Results:
Acute epidural hematoma occurs between the dura and the skull plate hematoma, accounting for traumatic intracranial hematoma 20-30%; Brain Injury incidence after subdural hematoma. Traumatic epidural hematoma is common in acute or acute onset special, the incidence rate of about 85%, subacute hematoma incidence of 11%, about 4% of those with chronic, rare. For October 2013 - October 2015 in our hospital patients suffering from acute epidural hematoma in 260 cases for the study. 170 cases were male, female 90 cases, male: female = 1.9: 1. Aged 8 to 68 years, mean age (38.6 ± 9.8) years, these patients, 8 to 18 years 46 cases, 19 to 28 years old, 38 cases, 29 to 38 years, 65 cases, 39 to 48 55-year-old cases, 49 to 58 years of 30 cases, 59 to 68 years old, 26 cases of patients with traumatic brain injury upcoming random grouping, comparing two groups of patients in the influence of gender and age on the occurrence of cerebral infarction when, P＞ 0.05, no significant differences, not much statistical significance, in the multi-factor Logistic regression analysis when the patient enters the hospital, due to lower systolic blood pressure, subdural hemorrhage , cerebral contusion, subarachnoid hemorrhage, GCS ＜8 points, head fractures and other factors, cerebral infarction and cerebral edema after these factors with the patient during craniotomy closely related, appear in postoperative cerebral infarction and cerebral edema was found for patients timely diagnosis and early treatment is related to the patient＇s quality of life, as soon as possible if the patient＇s head CT and MRI plane can fire more accurately detect cerebral lesions [5].
Conclusion:
Acute epidural hematoma bleeding more ferocious, excessive bleeding if the patient should promptly release intracranial hypertension, otherwise it will endanger the safety of life. Hernia acute epidural hematoma is the displacement of brain tissue brain tissue caused by an imbalance of pressure, brain herniation occurs further cause adverse symptoms such as cerebral infarction and cerebral edema can cause dangerous symptoms of the brain, diffuse axonal injury and multiple brain injury will result in the emergence of hernia, if the cause of cerebral infarction and cerebral edema occurs, the consequences could be disastrous, would seriously threaten the lives and safety of the patient, to make this as soon as possible diagnosis [6]. It may be more sophisticated instruments such as: multi-faceted CT and MRI for detecting and timely lifting of the oppression of the brain. According to the patient＇s disease severity given specific treatment, it can be treated [7] intracranial surgery. Through this study show : hernia acute epidural hematoma caused by cerebral infarction and cerebral edema caused by the following factors: hematoma, subdural brain contusion, lower systolic blood pressure, brain injury forces is an important factor, in addition there are factors in vivo fibrinolytic blood disorders, low perfusion, etc. can lead to cerebral infarction, cerebral infarction occurs is the result of brain damage blood vessels, the capillaries of the brain injury BBB will disorders, blood in the water will seep into the surrounding tissue and cell gap, further development of cerebral edema [8]. If traumatic intracranial greater the probability of infarction and brain edema also will be higher, the prognosis is poor, cerebral infarction and cerebral edema caused by trauma, the effects of treatment and will not be too obvious, but most prognosis poor [9]. More and more clinicians advocate patient through imaging MRI and CT perfusion imaging technologies to make its early diagnosis of disease, the patient to be able early surgical treatment of intracranial decompression, reducing the risk of life of patients, treatment the technology can be selected intracranial arterial anastomosis outside, can also be brain infarction in patients with arterial thrombolytic complement, the use of drugs can be anticoagulation and prevention of vascular spasm. After this study caused Clinical doctors attaches great importance to further deepen explore this research, improve the survival rate of cerebral infarction and cerebral edema caused by acute epidural hematoma caused by herniation, improve the prognosis of the disease [10] .
