重型创伤性脑损伤患者去骨瓣减压术后硬膜下积液的治疗方法  

Treatments of subdural effusion following decompressive craniectomy in patients with severe traumatic brain injury

作　　者：李志红[1] 李玉骞[1] 柴磊[1] 杨彦龙[1] 高立[1] 李敏[1] 张兴业[1] 常涛[1] 郭清保[1] 罗涛[1] 李立宏[1] 

机构地区：[1]第四军医大学唐都医院神经外科,西安710039

出　　处：《中华创伤杂志》2016年第7期607-611,共5页Chinese Journal of Trauma

摘　　要：目的探讨重型创伤性脑损伤（sTBI）患者行去骨瓣减压术（DC）后硬膜下积液（SE）的治疗措施及效果。方法回顾性分析2013年1月-2015年1月行DC后发生SE的56例sTBI患者资料。其中男38例，女18例；年龄12～76岁[（36．1±13．5）岁]。致伤原因：交通伤42例，高处坠落伤7例，击伤4例，重物砸伤3例。发生减速性、加速性及挤压伤分别为45例、8例和3例。术前格拉斯哥昏迷评分（GCS）均≤8分。行单侧DC49例，双侧7例。SE位于DC同侧39例，对侧10例，双侧7例。所有患者依据SE量不同，分别给予加压包扎、穿刺引流、颅骨修补及积液腔一腹腔分流手术治疗。观察患者SE量，设定SE量≤15ml为治愈标准。结果12例SE量≤30ml的患者经非手术治疗后，仅2例SE量增加需手术治疗；44例初始SE量〉30ml及2例非手术治疗SE量增加〉30ml的患者给予外科干预，反复利用穿刺引流及加压包扎方法治疗后5例仍复发，行积液腔一腹腔分流后积液控制。所有患者SE控制后均行颅骨修补术。术后复查示残余SE量均≤15m1。结论对于DC后硬膜下积液患者，采取非手术治疗、穿刺引流及加压包扎、积液腔一腹腔分流、颅骨修补术的阶梯式治疗方案可有效控制SE的发生及发展。Objective To analyze the therapeutic effect of different methods on subdural effusion after decompressive craniectomy （DC） in patients with severe traumatic brain injury （sTBI）. Methods Fifty- six patients （38 males and 18 females） who developed subdural effusion following DC from January 2013 to January 2015 were reviewed retrospectively. Age was （36. 1 ± 13.5 ） years （ range, 12-76 years）. Brain injury was from traffic accident in 42 patients, high fall in 7, trauma in 4 and hit by heavy objects in 3. There were 8 patients with accelerated injury, 45 decelerated injury and 3 crush injury. Preoperative Glasgow Coma Scale （GCS） score was ≤8 points. Forty-nine patients underwent unilateral DC arid 7 bilateral DC. Subdural effusion was found at surgery side in 39 patients, the contralateral side in 10 and both sides in 7. Based on the amount of effusion, the patients were respectively treated with pressure dressing, puncture drainage, cranioplasty or subduro-peritoneal shunt. Effusion ≤15 ml was considered to be the criterion of cure. Results Twelve patients with subdural effusion ≤ 30 ml were treated conservatively, and only two developed increased subdural effusion that required surgical intervention. Forty-four patients with the original subdural effusion 〉 30 ml were given repeated drainage and pressure dressing directly. After surgery, five patients relapsed again and were controlled after subduro-peritoneal shunt. All patients received cranioplasty when subdural effusion was cured. Subdural effusion was all ≤15 ml after operation. Conclusion Stepped care including non-operation, puncture drainage and pressure dressing, subduro-peritoneal shunt and cranioplasty is effective in controlling the occurrence and progression of subdural effusion.

关 键 词：减压颅骨切除术 硬膜下积液 脑损伤 引流术 

分 类 号：R651.15[医药卫生—外科学]