微创穿刺治疗小儿硬膜外血肿  

Minimally invasive puncture operation of pediatric epidural hematoma

作　　者：史占华[1] 赵鸿玲[2] 颉卫东[1] 

机构地区：[1]包头市中心医院神经外科,内蒙古包头014010 [2]内蒙古包头市北方医院功能科

出　　处：《中国冶金工业医学杂志》2016年第1期6-7,共2页Chinese Medical Journal of Metallurgical industry

摘　　要：目的探讨小儿硬膜外血肿微创穿刺手术的优点。方法根据CT片定位,以血肿厚度最大层面为穿刺点,取YL-I型一次性粉碎穿刺针自穿刺点垂直于头皮钻入,放出部分血肿,然后用稀释有尿激酶的生理盐水缓慢冲洗,术后CT评估去除血肿已起到减压作用后,用生理盐水3ml＋2万单位尿激酶注入血肿腔内夹闭引流管2h后开放,每日重复1次,2d后再次复查头CT了解血肿情况后决定是否拔除穿刺针。结果术后立即CT复查均无血肿增大表现,其中有2例患儿手术后CT复查血肿已清除彻底,术后2d后再次复查头CT其余病例显示血肿基本消失,出院时根据GOS评分,均达到恢复良好标准。结论微创穿刺手术是小儿硬膜外血肿的理想治疗手段,能降低患儿的手术风险,减少患儿并发症,缩短住院时间。Objective To investigate the advantages of minimally invasive puncture operation of pediatric epidural hematoma.MethodsAccording to CT imaging,the maximum level of hematoma was chosen as puncture point,with one-time crushing puncture needle of type YL-I,penetrating at puncture point perpendicular to the scalp,release part of the hematoma,then wash the cavity of hematoma with 0.9% sodium chloride injection with diluted urokinase gently,evaluating the effect of removing partial hematoma and decreased pressure by CT after operation,inject 3ml 0.9% sodium chloride injection and 20000 uurokinase into hematoma cavity and clip the drainage tube 2hours,after open it,repeat 1~2 times each day,brain CT scan were underwent after 2 ~ 3 days to observe hematoma and decide whether to pull out puncture needle.ResultsCT scan were underwent immediately after operation,all patients revealed no hematoma increasing,including 2 cases of hematoma being removed thoroughly;all patients were well as recovery according to GOS scores when they leaved from hospital.Conclusion The minimally invasive puncture operation is an ideal treatment for pediatric epidural hematoma,can reduce the risk of operation and the incidence of complications,shorten hospitalized time.

关 键 词：穿刺 小儿 硬膜外血肿 

分 类 号：R726.5[医药卫生—儿科]