急性硬膜外血肿合并脑疝患者32例救治分析

目的探讨硬通道血肿微创穿刺术联合开颅血肿清除术对急性硬膜外血肿合并脑疝患者的临床治疗价值。方法对我科2003年1月～2007年8月收治的32例急性硬膜外血肿合并脑疝患者，首先利用YL-1型颅脑穿刺针进行血肿微创穿刺清除颅内部分血肿，随即开颅清除血肿（微创＋开颅组），伤后6月至1年随访，按GOS预后评分评估疗效，与1997年1月～2002年12月收治的行常规开颅清除血肿治疗的43例（常规开颅组）患者进行对比。结果与常规开颅组相比，微创＋开颅组总体死亡率明显下降（x2=4．50，0.05〉P〉0．01），预后良好率显著提高（x2=9．93，P〈0．01）。结论早期血肿微创穿刺术联合开颅血肿清除术能够降低急性硬膜外血肿合并脑疝患者的致残率和残死率，提高治疗效果。

Analysis of the treatment of 32 patients with acute extradural hematoma and brain hernia

Objective To explore the clinical effect of evacuation of hematoma by way of the combination of microinvasive craniopuncture and craniotomy on patients with acute extradural herhatoma and brain hernia. Methods 32 cases with acute extradural hematoma and brain hernia which were hospitalised from 2003.1 to 2007.8 were treated as follows： The acute extradural hematoma was partly drained through microinvasive craniopuncture with YL-1 puncture needle as first aid treatment. Then the hematoma was removed through craniotomy. Results At 6 to 12 month follow-up, Glasgow outcome scale showed that overall mortality dropped （X2= 4.50, 0.05 〉p〉0.01） and the rate of favourable outcome increased （%2=9.93, p〈0.01）, in comparison with that of the patients who were given routine removal of hematoma during the period of 1997.1 to 2002.12. Conclusion The combination of microinvasive craniopuncture and craniotomy has good effect on patients with acute extradural hematoma and brain hernia. It can reduce the mortality and improve curative effect.