非急性颅内压增高硬膜外血肿的治疗体会  

Treatment of non-acute increased intracranial pressure in epidural hematoma

作　　者：金星一[1] 刘乃杰[1] 于伟东[1] 秦治刚[1] 赵丛海[1] 

机构地区：[1]吉林大学中日联谊医院神经外一科,长春130033

出　　处：《中华脑科疾病与康复杂志（电子版）》2012年第1期26-29,共4页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

摘　　要：目的探讨非急性颅内压增高硬膜外血肿治疗方法的选择。方法吉林大学中日联谊医院于2003年1月至2011年10月收治非急性颅内压增高硬膜外血肿患者59例,保守治疗32例,伤后限期行血肿钻孔引流术、术后血肿腔内注射尿激酶19例,行血肿清除术及相关手术8例。应用SPSS 13.0统计分析软件进行统计学分析,对手术治疗患者中有意识障碍和无意识障碍例数比较及硬膜外血肿出血量范围中采取手术治疗的患者例数比较分别行卡方检验。P<0.05为差异有统计学意义。结果随诊3个月至2年,预后良好者56例,占总病例的94.9%,轻残2例,中残1例,手术治疗无意识障碍患者及意识障碍患者20例和7例,与无意识障碍患者的40.0%及有意识障碍患者总数的77.8%,两者比较差异具有统计学意义(χ2=4.39,P<0.05);血肿量≤10 ml患者手术治疗2例,约占6.5%,血肿量>10 ml患者手术治疗25例,约占89.3%,两者比较差异有统计学意义(χ2=40.67,P<0.05);对血肿部位位于额颞顶部位的53例患者行手术治疗24例,约占45.3%,而血肿部位位于枕部或后颅窝的6例患者均行手术治疗。结论对于非急性颅内压增高硬膜外血肿的患者采取恰当的临床治疗方法(钻孔引流术),可以使大多数患者达到理想的治疗效果。Objective To investigate the choice of treatment of non-acute increased intracranial pressure in epidural hematoma. Methods Of all the 59 patients with non-acute increased intraeranial pressure in epidural hematoma who were hospitalized from January 2003 to October 20l 1, 32 cases received conservative treatment, 19 cases received hematoma burr hole drainage and postoperative hematoma cavity injection of urokinase, 8 cases received evacuation of hematoma. All data were put to SPSS 13.0 statistical software, Chi - square test were applied to compare the cases of patients with and without disturbance of consciousness and patients underwent surgery, P 〈 0.05 showed the difference was significant statistically. Results Patients were followed up for 3 months to 2 years, 56 cases showed good prognosis, （94.9% of the total cases）, 2 cases showed mild disability, one case showed moderate disability. Twenty patients with disturbance of consciousness were cured （40. 0% of the total ）, 7 patients without disturbance of consciousness were cured（77.8% ）, there was significant difference in two groups （X2 = 4.39, P 〈 0.05 ）. Two patients with hematoma volume greater than 10 ml were cured（6.5% of the total）, 25 patients with hematoma volume less than 10 ml were cured（89.3% of the total）, there was significant difference in two groups （x^2= 40.67,P 〈 0.05）. Of all the 53 patients with hematoma located in frontotemporal, 24 received operation（45.3% ） , of all the 6 patients with hematoma located in posterior fossa, 6 patients received operation. Conclusions Most patients with non-acute increased intracranial pressure in epidural hematoma can achieve the desired therapeutic effect if take appropriate clinical treatment （burr hole drainage）.

关 键 词：血肿 硬膜外 颅内 引流术 尿激酶 

分 类 号：R651.1[医药卫生—外科学]