YL-1型针引流联合尿激酶治疗慢性硬膜下血肿48例

目的探讨硬通道联合尿激酶冲洗引流治疗慢性硬膜下血肿的临床疗效。方法 48例慢性硬膜下血肿患者,根据Bender分级：0级3例、Ⅰ级10例、Ⅱ级27例、Ⅲ级8例、Ⅳ级0例。应用YL-1型一次性颅内血肿粉碎针穿刺冲洗引流血肿,术后小量生理盐水等量反复冲洗,24h后复查头颅CT,对残留血肿辅以尿激酶纤溶治疗,2～3次/d,直至血肿基本清除,并分析硬通道联合尿激酶冲洗引流术的安全性和实用性。结果 48例均一次性成功,经过3～7d冲洗引流,血肿清除。出院时重新对患者进行Bender分级评分：0级37例、Ⅰ级8例、Ⅱ级3例、Ⅲ级0例、Ⅳ级0例。均无颅内出血、颅内感染、急性脑膨胀、张力性气颅及癫痫等并发症发生,48例患者出院1月后复查头颅CT无复发。结论硬通道联合尿激酶治疗硬膜下血肿手术安全可靠、创伤小、方法简便易行,清除血肿迅速,值得临床推广使用。

Effect of Burr-hole Irrigation and Drainage Combined with Urokinase on Chronic Subdural Hematoma

Objective To investigate the clinical effects of burr-hole irrigation and drainage combined with urokinase on chronic subdural hematoma（CSDH）.Methods The clinical data of 48 cases with CSDH were retrospectively analyzed.According to Bender Classification,three patients were with grade 0,10 with gradeⅠ,27 with gradeⅡ,8 with gradeⅢ,and no grade Ⅳ.All cases underwent the burr-hole irrigation and drainage combined with normal saline equivalently.Head CT scanning was accomplished 24 hours later.Urokinase was injected into remained hematoma by two or three times per day until hematoma has completely cleaned.Bender Classification at discharge and head CT scanning at 30th days after discharge were used to evaluate the therapeutic effects.The safety and practicability of this therapy also were evaluated.Results Hematoma was eliminated three to seven days after irrigation and drainage.The Bender Classification scale at discharge were grade 0 in 37 cases,gradeⅠin 8,and gradeⅡin 3.There was no obvious complication,such as intracranial hemorrhage,intracranial infection,acute brain inflation,tension pneumocephalus,and epilepsy,etc.in all cases.No recurrent hematoma occurred by head CT scanning 30 days after discharge.Conclusion Burr-hole irrigation and drainage combined with urokinase injection is effective for patients with CSDH.It is a safe treatment method for CSDH and worthy to be popularized.