目的：探讨首诊时伴有急性出血的慢性硬膜下血肿（chronic subdural hematoma，CSDH）手术疗效及 预后。方法：回顾性分析单中心手术治疗的166例CSDH患者的临床资料，其中28例为CSDH合并急性出 血（acute-on-chronic subdural hematoma，acSDH），探讨该特殊类型CSDH手术疗效及预后。结果：acSDH占 同期CSDH的16.87%。和不伴有急性出血的CSDH比较，acSDH术后并发症发生率高（P＜0.05）；而复发 率、总住院时间、出院时改良Rankin评分（modified Rankin scale，mRS）、手术疗效良好率，两者比较差异无 统计学意义（P＞0.05）。 acSDH患者的30 d和1年死亡率高于不伴有急性出血的CSDH患者，但差异无统 计学意义（P＞0.05）；Kaplan-Meier法描述2组患者生存曲线，生存率差异无统计学意义（P＞0.05）。结论： 首诊acSDH患者较不伴急性出血的CSDH患者术后并发症发生率高，但复发率差异无统计学意义，acSDH 手术疗效良好。

To explore the surgical outcomes and prognosis of chronical subdural hematoma (CSDH) with acute hemorrhage at the initial presentation. Methods: A retrospective analysis was conducted on the clinical data of 166 patients with CSDH who underwent surgical treatment in a single center. Among them, 28 cases were diagnosed with acute-on-chronic subdural hematoma (acSDH), and the surgical outcomes and prognosis of this special type of CSDH were explored. Results: Acute chronic subdural hematomas (acSDH) accounted for 16.87% of all chronic subdural hematomas (CSDH) during the same period. Compared to CSDH without acute hemorrhage, patients with acSDH exhibited significantly higher postoperative complication rates (P<0.05). However, no statistically significant differences were observed between the two groups in terms of recurrence rate, total hospital stay duration, discharge modified Rankin scale (mRS) scores, or favorable surgical outcome rates (P>0.05). Although mortality rates at both 30 days and 1 year were numerically higher for acSDH cases, these differences did not reach statistical significance (P>0.05). Kaplan-Meier survival analysis revealed overlapping survival curves for both cohorts, with no significant intergroup difference in survival probability (P> 0.05). Conclusion: Patients initially diagnosed with acSDH experience higher postoperative complication rates compared to those without acute hemorrhage, yet exhibit similar recurrence rates. Surgical treatment for acSDH yields favorable outcomes.