放血疗法治疗难以控制的外伤性颅内高压  

Superior sagittal sinus blood draining for treatment of traumatic uncontrollable intracranial hypertention

作　　者：张光辉[1] 王德虎[1] 刘鹏[1] 吴欣洪[1] 金丹[1] 殷翠[1] 陈道文[2] 梅保君[3] 

机构地区：[1]中国葛洲坝集团中心医院神经外科,宜昌443002 [2]中国葛洲坝集团中心医院CT室,宜昌443002 [3]中国葛洲坝集团中心医院麻醉科,宜昌443002

出　　处：《中华神经外科杂志》2000年第3期168-170,共3页Chinese Journal of Neurosurgery

摘　　要：目的　进行临床对照试验 ,验证上矢状窦放血治疗外伤性难以控制颅内高压的疗效和安全性。方法　选择伤后 6小时以内 ,GCS 3～ 8分 ,并具有CT特征的急性弥漫性脑肿胀患者 2 6例 ,接受经上矢状窦放血疗法 ,以未采用放血疗法的同类患者 2 4例作为对照组。分析比较死亡率 ,致残率和ICP、VSP及GCS、GOS等指标变化情况 ,随访 3～ 6个月。结果　上矢状窦放血疗法治疗组死亡率、病残率明显低于对照组。ICP和VSP分析 ,经常规方法治疗后 ,ICP持续升高难以控制时 ,经上矢状窦放血可显著降低ICP ,同时VSP升高 ,有助于脑静脉回流 ,改善脑瘀血。Objective To testify the treatment effect and the safty quality of sinus sagittalis superior blood draining treatment for traumatic intracranial hypertention.Methods 26 selected cases with acute diffuse cerebral swelling which were characterized by CT feature and scored 38 by GCS after head injury within 6 hours were treated by sinus sagittalis superior blood draining, while other 24 similar patients without blood draining as the control. The variasion of the parameter such as the mortality, morbidity, ICP, GCS and GOS between these two groups were evaluated after 36 months.Results The mortality and morbidity of sinus sagittalis superior blood draining group were much lower than those of the control group. From the analysis of ICP and VSP, if increased ICP could not be controlled efficiently after conventional treatments, sinus sagittalis superior blood draining could reduced ICP quickly and effectively, meanwhile, if the VSP rised steadly. It can also speed up the return blood volume of brain, allievate cerebral ecchymosis and improve cerebral circulation. Conclusion Blood draining can help to decrease the mortality and morbidity of the patients with traumatic uncontrollable intracranial hypertention.

关 键 词：脑外伤 颅内高压 放血疗法 病例报告 

分 类 号：R651.15[医药卫生—外科学]