硬膜外血肿钻孔引流术的临床观察.docVIP

硬膜外血肿钻孔引流术的临床观察 摘要:目的：探讨颅骨钻孔结合尿激酶微创治疗外伤性硬膜外血肿的疗效。方法：对我院外伤性急性、亚急性及慢性硬膜外血肿患者，选取部分病例在血肿最厚层面采用颅骨钻孔，置12～14号硅胶管入血肿腔，并用尿激酶血肿腔内注射后引流，观察疗效并加以总结。结果：30例患者均一次穿刺成功，术前、术后硬膜外血肿量经配对t检验，t值为17.87，p值0.01，具有统计学差异；术前、术后GCS评分采用配对比较的秩和检验，p值0.01，具有统计学差异；术前血肿量与GCS评分采用Spearman相关分析，r值为-0.065，p=0.753，无统计学相关关系；术后血肿量与GCS评分采用Spearman相关分析，r值为0.148，p=0.436，无统计学相关关系。 结论：正确把握硬膜外血肿的手术适应证和禁忌证，颅骨钻孔结合尿激酶微创治疗硬膜外血肿是一种简单、安全而有效的手段。 关键词:硬膜外血肿，颅骨钻孔，尿激酶 Clinical Analysis of trephination and drainage treatment for epidural hematoma SUN Tao, SHU He-xian, MA Jun, LI Jian. Department of Neurosurgery, The first Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China Abstract: Objective: To discuss the therapeutic effect of minimally invasive treatment to traumatic epidural haematoma with drilling skull plus urokinase. Method: Reviewing retrospective analysis on the clinic data of 30 traumatic epidural hematoma patients including acute，subacute and chronic cases，who received drill skull plus urokinase and drainage treatment in our hospital. Result: All the 30 cases were successfully operated, Preoperative Epidural haematoma volume is significantly different from postoperative volume with paired-samples t test(t value was 17.87, p0.01), Preoperative GCS is significantly different from postoperative volume with rank sum test (p0.01), Preoperative and postoperative Epidural haematoma volumes are not correlated to GCS with Spearman correlation analysis (p0.05). Conclusion: Drilling skull plus urokinase for treatment of traumatic epidural haematoma is a safe and effective method, based on correctly grasping the indications and contraindications of surgery. Key: epidural haematoma, drilling skull, urokinase 硬膜外血肿约占外伤性颅内血肿20%~30%[1]，如果诊断与处理不恰当、不及时，直接威胁病人的生命。随着现代影像学与监护设施的发展，对硬膜外血肿患者病情的充分了解，微创治疗硬膜外血肿成为一种简单、有效的手术方法，2007年1月至2010年7月，笔者选取我院30例硬膜外血肿病例，采取微创钻孔引流术，收到了良好的效果，现报告下。 1 资料与方法 1.1 临床资料 本组硬膜外血肿30例，男22例，女8例，年龄6～72岁，平均40.7±18.0岁；受伤原因：车祸20例，打击伤7例，坠落伤3例；急性9例，亚急性18例，慢性3例。临床表现 头痛20例，头晕18例，恶心、呕吐21例，偏瘫3例，偏身感觉障碍3例，癫痫发作