만성 경막하 혈종에서, 단순 배액술 후 뇌실질 팽창에 영향을 미치는 요소
Factors Affecting Brain Re-expansion after Simple Burr Hole Drainage in Chronic Subdural Hematoma
소속 상세정보
이승철/Seung Cheol Lee
강재규/정현태/도종웅/Jae Kyu Kang/Hyun Tae Jung/Jong Oung Dho
KMID : 0359819980270060757
Abstract
서 론
만성 경막하혈종은 외상에 의해 경막과 지주막 사이의 혈관들이 손상되어 발생하는 비교
적 흔한 질환이며 일반적으로 수상후 진단까지의 기간이 3주 이상 경과한 것이다. 치료로
비수술적 요법 뿐만 아니라 소천공 배액술(Twist-drill craniotomy), 단순 천공 -배액술, 또
는 개두술 및 피막제거술등의 다양한 수술적 시도가 있어왔다 현재 비수술적 요법은 큰 치
료 효과를 기대할 수 없는 것으로 알려져 있으며, 개두술을 요하는 몇가지 경우를 제외하고
일반적으로 단순 천공-배액술을 시행함으로써 높은 치료 성공률을 보인다. 그러나 단순 천
공-배액술후 뇌팽창이 지연되는 경우가 종종 있다. 저자들은 단순 천공-배액술후 뇌팽창에
영향을 주는 요소들을 밝혀 치료 효과의 판정과 예후의 예측에 도움을 얻고자 하였다.
#초록#
Delayed brain re-expansion is one of the most frequent problems on the chronic
subdural hematoma. The aim of this study is to determine the factors affecting brain
re-expansion. The study consists of 76 patients with the chronic subdural hematoma
treated primarily by simple burr-hole drainage from january 1992 to December 1996.
Clinical records and radiologic studies were reviewed retrospectively. The age
distribution ranged from 22 to 82 years(mean 64 years). the male-to-female ratio was
1.8:1(49:27). At the 2nd. 4th, 6th and 12th week after surgery. the follow-up study was
performed with computed tomograpy or magnetic resonance image. Complete brain
re-expansion was defined that the subdural space was 5㎜ of less without midline shift
on computed tomograpy or magnegic resonance image. The factors interfering the brain
re-expansion are as follow ; old age. low Glasgow Coma Scale(GCS)score on admission.
history of chronic alcohol consumption. hypodense hematoma on compused tomograpy.
bliateral hematoma. disapperance of intraoperative brain pulsation. and long duration after
trauma. The results of this study may be helpful to predict the brain re-expension after
burr-hle drainage. if the complete brain re-expansion is not observedimmediately, it
should be for 6 works to condust the follow-up study. Patient's position and sufficient
hydration are important for brain expansion. Further investigations on other factors
related to promotion of the brain re-expansion should be followed.
키워드
Chronic subdural hematoma; Head injury; Berr-hole drainage; Brain re-expansion;
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