置氧法治疗对老年慢性硬膜下血肿患者脑组织结构和功能的保护作用(英文)  

Protective effect of oxygen-exchange therapy on cerebral tissue structure and function in the elderly with chronic subdural hematoma

作　　者：董欣明[1] 袁玉会[1] 潘蔚然[1] 王成林[1] 

机构地区：[1]中国医科大学第二临床学院神经外科110003

出　　处：《中国临床康复》2005年第45期176-176,共1页Chinese Journal of Clinical Rehabilitation

摘　　要：背景:老年慢性硬膜下血肿以往均采用传统的颅骨钻孔冲洗引流术,近年来更多采用经颅骨硬脑膜穿刺置氧法。目的:探讨锥孔置氧法新术式的可靠性和安全性。并与传统术式进行比较。设计:回顾性病例分析。单位:中国医科大学第二临床学院神经外科。对象:于1997-01/2004-12选择中国医科大学第二临床学院神经外科行颅骨锥孔置氧法治疗未使用引流管的男性住院患者11例,平均年龄62岁。平均病史1.5个月,10例有不同程度的头外伤。外伤史最短6周,最长9周,平均7周。均以头疼为主诉,其中5例有不同程度的一侧肢体无力(在Ⅳ级以上)。均经头CT,MRI确诊为慢性硬膜下血肿,有8例行MRI检查。血肿部位均为幕上,右侧5例、左侧6例。血肿量:按长×宽×层面(1cm/层),计数最少70mL,最多140mL,平均105mL,占位效应为均有不同程度的中线移位。方法:患者在床头取侧卧位,经CT定位取血肿最厚处锥孔。局部麻醉下以0.4～0.5cm骨锥锥孔,用14号腰穿针套管针刺硬膜,拔出针芯,可见血自动流出。待血不流后注入10mL过滤医用氧气,再使血肿在压力下自动流出。反复注入过滤氧气,10mL/次,直至无血自动流出,再注入10mL过滤氧并同时拔出套管针包扎。记录每例患者累计置氧量。术后可根据患者心功能情况尽量加大加快输液量,输液时间平均为2周。主要观察指标:肢体功能改善情况。结果:11例患者全部进入结果分析。①24h内复查头CT,血肿均明显减少,其中3例完全消失。3周后中线结构对称,诸脑室形态正常,头疼消失。5例术前肢体无力患者肢恢复正常。②颅骨锥孔置氧法治疗老年慢性硬膜下血肿的优缺点:优点:手术简单在床头即可手术、时间短、术后并发症少,术后活动不受限制,避免了下肢血栓形成。颅内压不会迅速下降,置氧后包膜内有一定压力,从包膜(半透膜)外进入包膜内的脑脊液在压力始�BACKGROUND： Traditionally, cranial perforate-rinse-dram operation and tube drainage were often used in the treatment of chronic subdural hematoma in the elderly, recently,instead of which oxygen-exchange therapy through dural puncture via cranium is more and more used. OBJECTIVE： To investigate the reliability and safety of the new operation-method using oxygen-exchange in treating the older people with chronic subdural hematoma in comparison with traditional cranial perforate-rinse-dram operation. DESIGN： Retrospective case analysis. SETTING： The Department of Neurosurgery, the Second Clinical College of China Medical University. PARTICIPANTS： Eleven male patients （meanly 62 years of age） who had undertaken oxygen-exchange therapy via skull without drain tube in the Department of Neurosurgery, Second Clinical College of China Medical College from January 1997 to December 2004 Were enrolled in the study, with an average disease history of 1.5 months. Among them, 10 subjects suffered from head injury to different extent within 7 weeks on average. Main chief complaint was headache, and Unilateral limb asthenia above 1V was found in 5 cases asking for medical service. As shown by CT and MRI, all the subjects were diagnosed as having chronic subdural hematoma located at supratentorium, 5 cases in the right side and 6 in the left side. Volume of hematorn was calculated as the following formula： volume of hematom=length×width×number of layers （1 cm thick for one layer）. And the range of volume was from 70 mL to 140 mL, and the average value was 105 mL. The hematom in all the cases was found to move to the midline to different extents. METHODS： Patients in lateral recumbent position were undertaken boring at the CT-located thickest area with bone awl of 0.4-0.5 cm under local anesthesia. After boring, 14-size lumbar puncture needle with trochar was used to acupuncture dura mater then moving the needle core so that blood was discharged. Then 10 mL medical oxygen was perfused into the nee

关 键 词：血肿 硬膜下 老年人 氧 

分 类 号：R651.15[医药卫生—外科学] R47[医药卫生—临床医学]