微创穿刺术在急诊抢救外伤性颅内血肿中的应用  

Emergent treatment of severe traumatic intracranial hematoma with minimally invasive technique

作　　者：徐爱民[1] 李春盛[1] 顾征[2] 郝伟[1] 

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,北京100020 [2]首都医科大学附属北京朝阳医院神经外科,北京100020

出　　处：《中华急诊医学杂志》2007年第10期1066-1069,共4页Chinese Journal of Emergency Medicine

摘　　要：目的探讨微创穿刺术在急诊抢救外伤性颅内血肿的应用价值。方法回顾性分析1995年1月到2005年12月于我院应用微创穿刺术抢救脑疝阶段的外伤性颅内血肿患者126例的临床资料,以术前CT片为依据,确定穿刺点、置管方向及深度,在急诊手术室局麻下行微创穿刺并置管引流的方法。结果本组穿刺成功率100%。瞳孔散大患者经引流后瞳孔均有不同程度缩小,单侧瞳孔散大组79/95例(83.1%);双侧瞳孔散大组17/31(54.8%),以临床即时效果评价的总有效率76.2%。根据GOS结果分级:良好48例,中残26例,重残18例,植物生存16例,死亡18例。结论微创穿刺术可快速改善脑疝症状,缩短脑疝时限,延长开颅手术的时间窗,是一种有效的抢救手段,同是也是创伤急救医生有必要掌握的一种确定性救命手术技术。Objective To evaluate the value of minimally invasive technique in treatment of severe traumatic intracranial hematoma at emergency department. Method From January 1995 to December 2（105, 126 patients were treated by using the minimally invasive technique in Affiliated Chaoyang hospital once patients were diagnosedas severe traumatic cerebral hernia resulted from intracranial hematoma and also those whose clinical data were retrospectively analyzed. In the emergency department, the per-operative plan was done according to the CT imaging, including the sute of burr hole on the skull, the direction and depth of cannulation, and the drainage cannula was put into the hematoma cavity for external drainage under local anesthesia. Results The successful rate of puncture was 100%. The patients＇ s dukated oyouk contracted immediately after drainage. There are 79/ 95 patients （83.1%） had single pupil dilated and 17/31 （54.8%） patients had bilateral pupils dilated. The immediately chnical effective was 76.2%. According to Glasgow outcome scale, 43 of 126 patients had good recovery, 26 had moderate deficits and 18 had severe sequelae, 16 patients were in vegelative slate, 18 died.Conclusions Clinical prospective study proves that minimally invasive technique can amehorate the cerebral hernia, prolong the operative therapic window time.

关 键 词：外伤性颅内血肿 脑疝 微创穿刺 

分 类 号：R651.15[医药卫生—外科学]