术前引流对硬膜下血肿伴脑疝开颅减压的疗效研究
摘要
目的研究分析创伤硬膜下血肿伴脑疝患者在常规开颅减压术前行硬通道穿刺血肿引流的临床疗效。方法选取2014年1月至2018年12月本院收治的硬膜下血肿伴脑疝患者共72例,治疗医师根据手术方法不同按照入院顺序将所有患者分为两组,其中A组38例,先行硬通道穿刺抽吸引流血肿后再行开颅减压术治疗,B组34例,行常规开颅减压手术治疗;观察A组与B组患者从确诊至已完成减压时间、手术结束后患者清醒时间、住院时间、出院时患者GOS评分等。结果 A组患者从确诊至已完成减压时间及住院时间均小于B组患者(P<0.05);A组患者手术结束后患者清醒时间中,3天以内(包含3天)、4～14天比例数明显多于B组患者,而超过15天及无法清醒或死亡者比例数明显小于B组患者,差异具有统计学意义(P<0.05);A组患者出院时恢复良好例数比例明显高于B组患者,差异具有统计学意义(P<0.05)。结论对于硬膜下血肿伴脑疝患者行开颅血肿清除减压术前进行硬通道穿刺血肿抽吸引流,可以有效迅速地降低颅内压,有利于解除血肿长时间压迫脑组织,术后患者清醒时间更短,预后相对更好,适合临床医师选择应用。
引文
1奴尔兰·沙那提别克.损伤控制理论在急性硬膜下血肿伴脑疝治疗中的应用[J].中国农村卫生,2016,19:76-77.
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4沈健,杨华.不同手术时机小骨窗显微手术治疗高血压脑出血与日常生活活动能力量表、格拉斯哥预后评分的相关性[J].中国老年学杂志,2017,37(2):354-356.
5李红星,彭肖肖,韩光良,等.硬通道穿刺引流术联合标准大骨瓣减压术治疗急性硬膜下血肿合并脑疝[J].中国临床神经外科杂志,2018,23(7):484-485.
6 Mata-Mbemba D,Mugikura S,Nakagawa A,et al.Intraventric-ular hemorrhage on initial computed tomography as marker of diffuseaxonal injury after traumatic brain injury[J].J Neurotrauma,2015,32(5):359-365.
7 Alagoz F,Yildirim AE,Sahinoglu M,et al Traumatic AcuteSubdural Hematomas:analysis of outcomes and predictive factorsat a single center[J].Turk Neumsurg,2017,27(2):187-191.
2 Hanmd M,Schuss P,Daher FH,et al.Acute traumatic subdurMhematoma:surgical management in the presence of cerebral her-niation-a single-center series and multivariate analysis[J].World Neurosurg,2016,94:501-506.
3 wu G,Wang L,Liu J.et al.Minimally invasive procedures re-duced the damages to motor function in patients with thalamic hematoma:observed by motor evoked potential and diffusion tensorimaging[J].J Stroke Cerebrovasc Dis,2013,22(3):232-240.
4沈健,杨华.不同手术时机小骨窗显微手术治疗高血压脑出血与日常生活活动能力量表、格拉斯哥预后评分的相关性[J].中国老年学杂志,2017,37(2):354-356.
5李红星,彭肖肖,韩光良,等.硬通道穿刺引流术联合标准大骨瓣减压术治疗急性硬膜下血肿合并脑疝[J].中国临床神经外科杂志,2018,23(7):484-485.
6 Mata-Mbemba D,Mugikura S,Nakagawa A,et al.Intraventric-ular hemorrhage on initial computed tomography as marker of diffuseaxonal injury after traumatic brain injury[J].J Neurotrauma,2015,32(5):359-365.
7 Alagoz F,Yildirim AE,Sahinoglu M,et al Traumatic AcuteSubdural Hematomas:analysis of outcomes and predictive factorsat a single center[J].Turk Neumsurg,2017,27(2):187-191.