地塞米松血肿腔灌洗在颅骨钻孔改良T管引流术治疗慢性硬脑膜下血肿中的应用效果  

Effect of hematoma cavity lavage with dexamethasone during modified T-tube drainage through skull drilling hole for chronic subdural hematoma

作　　者：孙峻峰[1] 李建义 张滨 王会荣 康宁[1] 高强[1] Sun Junfeng;Li Jianyi;Zhang Bin;Wang Huirong;Kang Ning;Gao Qiang(Department of Neurosurgery,Baoji People’s Hospital,Baoji 721000,China)

机构地区：[1]宝鸡市人民医院神经外科,宝鸡721000

出　　处：《中国实用医刊》2024年第20期16-20,共5页Chinese Journal of Practical Medicine

基　　金：陕西省宝鸡市卫生和计划生育局科研项目(2015-35)。

摘　　要：目的探讨地塞米松血肿腔灌洗在颅骨钻孔改良T管引流术治疗慢性硬脑膜下血肿(CSDH)中的应用效果。方法回顾性抽取2021年1月至2024年1月于宝鸡市人民医院行CSDH颅骨钻孔改良T管引流术的慢性硬脑膜下血肿患者68例,按照治疗方案将其分为地塞米松组(34例,给予0.9%氯化钠注射液+地塞米松血肿腔灌洗)和生理盐水组(34例,单用0.9%氯化钠注射液血肿腔冲洗)。术后每月复查颅脑CT影像,至残余积液、血肿完全吸收,血肿腔闭合情况。比较两组临床疗效及非张力性气颅量、硬膜下积液量、引流管保留时间、住院时间等临床指标;比较两组术后改良Rankin量表(mRS)评分预后不良率、出血率、感染率、慢性血肿复发率、血肿腔闭合情况。结果地塞米松组术后好转率为100%(34/34),生理盐水组术后好转率为97.06%(33/34),两组术后好转率比较差异未见统计学意义(P>0.05)。地塞米松组术后非张力性气颅量、硬膜下积液量略低于生理盐水组,地塞米松组引流管保留时间、住院时间略短于生理盐水组,但两组比较差异未见统计学意义(P>0.05)。术后,两组mRS评分预后不良率、出血率、感染率比较,差异未见统计学意义(P>0.05);术后,地塞米松组慢性血肿复发率低于生理盐水组,血肿腔早期闭合比例高于生理盐水组(P均<0.05)。结论慢性硬脑膜下血肿行颅骨钻孔改良T管引流手术中,单用0.9%氯化钠注射液血肿腔冲洗与0.9%氯化钠注射液+地塞米松血肿腔灌洗的手术效果相当;0.9%氯化钠注射液+地塞米松血肿腔灌洗没有增加围术期风险,且慢性血肿复发率降低,血肿腔早期闭合比例高,治疗效果更好。Objective To investigate the effect of hematoma cavity lavage with dexamethasone during modified T-tube drainage through skull drilling hole for chronic subdural hematoma(CSDH).Methods A total of 68 patients with CSDH who underwent modified T-tube drainage through skull drilling hole in Baoji People’s Hospital from January 2021 to January 2024 were retrospectively selected,and they were divided into the dexamethasone group(34 cases,treated by hematoma cavity lavage with 0.9%sodium chloride injection and dexamethasone)and the normal saline group(34 cases,treated by hematoma cavity lavage with 0.9%sodium chloride injection)according to the treatment plan.The cranial CT image was performed for reexamination every month after surgery until the residual effusion and hematoma were completely absorbed,and the hematoma cavity was closed.The clinical efficacy and clinical indicators,including non-atonic pneumocetrial volume,subdural effusion,catheter retention time,and hospital stay of the two groups were compared.The postoperative modified Rankin scale(mRS)score showed poor prognosis rate,bleeding rate,infection rate,chronic hematoma recurrence rate,and the status of hematoma cavity closure of the two groups were compared.Results There was no significant difference in postoperative improvement rate between the dexamethasone group(100%,34/34)and the normal saline group(97.06%,33/34),P>0.05.The postoperative non-atonic pneumocetrial volume and subdural effusion volume in the dexamethasone group were slightly lower than those in the normal saline group,while the catheter retention time and hospital stay in the dexamethasone group were slightly shorter than those in the normal saline group,but there was no significant difference in the above indexes between the two groups(P>0.05).There was no significant difference in mRS score showed poor prognosis rate,bleeding rate and infection rate between the two groups after surgery(P>0.05).The recurrence rate of chronic hematoma in the dexamethasone group was lower than that in the

关 键 词：慢性硬脑膜下血肿 地塞米松 血肿腔灌洗 并发症 血肿复发 血肿腔闭合时间 

分 类 号：R651.1[医药卫生—外科学]