穿刺引流治疗急性创伤性脑内血肿

目的探讨急性创伤性脑内血肿穿刺清除治疗的可行性、疗效及适应证，提高救治成功率、改善预后。 方法选取自2000年1月至2013年5月在东营市人民医院神经外科收治的典型的急性创伤性脑内血肿患者27例，血肿量介于15~60 ml，CT摄片定位血肿中心及穿刺点，微创穿刺血肿，经抽吸、尿激酶液化引流清除血肿，3天内CT显示基本清除血肿后拔出穿刺针。 结果术后复查CT剩余血肿计量与术前对比，减少30%~60%，血肿均于3 d内基本清除。所有病例术后均稳定恢复，术前昏迷者10例，分别于术后1~5 d内清醒；头痛12例术后当天明显缓解，对侧肢体无力15例中术后好转3例，10例术后1月内逐渐好转；6月后遗留轻度语言障碍3例，对侧肢体力肌力3级2例，严重智能减退5例；继发脑积水1例、癫痫发作3例、无颅内积液、慢性血肿等。ADL分级1级18例、2级5例、3级4例。 结论穿刺清除治疗急性创伤性脑内血肿微创、预后好、并发症少。

Puncture and drainage in the treatment of acute traumatic intracranial hematoma

ObjectiveTo explore the puncture treatment of the acute traumatic intracerebral hematoma, clear the feasibility, curative effect and treatment indications, improve the prognosis and success rate of treatment. MethodsThere were 27 typical acute traumatic intracerebral hematoma cases from January 2000 to May 2003, the volume between 15-60 ml, CT positioning the center of hematoma and puncture point, minimally invasive puncture hematoma, then suction, urokinase liquefaction, drainage and clearance the hematoma, within 3 days pulling out the puncture needle after CT displaying of the hematoma clearanced almostly. ResultCompare the postoperative CT measurement with preoperative, the hematoma amount reduce 30%-60%, all of the hematoma was basic clearanced within 3 days. All cases were recovered, 10 cases with preoperative coma awaked after 1-5 days, 12 cases of headache symptom apparently alleviated on the day of surgery, contralateral limb weakness in 15 cases, 3 cases improved, after the operation 10 cases gradually improved a month later, 2 cases with limb light paralysis; 3 cases had mild language barriers 6 months later, contralateral limbstrength grade 3 in 2 cases, 5 cases of serious intellectual decline; secondary hydrocephalus in 1 cases, 3 cases of epilepsy, without intracranial effusion or chronic hematoma. According to the ADL classification, 18, 5, 4 weae in grade Ⅰ,gradeⅡ, gradeⅢ. ConclusionThe puncture removal treatment of acute traumatical intracerebral hematoma is minimally invasive, less complications, the prognosis is good.