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1、硬膜外血肿钻孔引流术的临床观察摘要:目的:探讨颅骨钻孔结合尿激酶微创治疗外伤性硬膜外血肿的疗效。方法:对我院外伤性急性、亚急性及慢性硬膜外血肿患者,选取部分病例在血肿最厚层面采用颅骨钻孔,置12~14号硅胶管入血肿腔,并用尿激酶血肿腔内注射后引流,观察疗效并加以总结。结果:30例患者均一次穿刺成功,术前、术后硬膜外血肿量经配对t检验,t值为17.87,p值<0.01,具有统计学差异;术前、术后GCS评分采用配对比较的秩和检验,p值<0.01,具有统计学差异;术前血肿量与GCS评分采用Spearman相关
2、分析,r值为-0.065,p=0.753,无统计学相关关系;术后血肿量与GCS评分采用Spearman相关分析,r值为0.148,p=0.436,无统计学相关关系。结论:正确把握硬膜外血肿的手术适应证和禁忌证,颅骨钻孔结合尿激酶微创治疗硬膜外血肿是一种简单、安全而有效的手段。关键词:硬膜外血肿,颅骨钻孔,尿激酶ClinicalAnalysisoftrephinationanddrainagetreatmentforepiduralhematomaSUNTao,SHUHe-xian,MAJun,LIJia
3、n.DepartmentofNeurosurgery,ThefirstAffiliatedHospitalofBengbuMedicalCollege,Bengbu233004,ChinaAbstract:Objective:Todiscussthetherapeuticeffectofminimallyinvasivetreatmenttotraumaticepiduralhaematomawithdrillingskullplusurokinase.Method:Reviewingretrospec
4、tiveanalysisontheclinicdataof30traumaticepiduralhematomapatientsincludingacute,subacuteandchroniccases,whoreceiveddrillskullplusurokinaseanddrainagetreatmentinourhospital.Result:Allthe30casesweresuccessfullyoperated,PreoperativeEpiduralhaematomavolumeiss
5、ignificantlydifferentfrompostoperativevolumewithpaired-samplesttest(tvaluewas17.87,p<0.01),PreoperativeGCSissignificantlydifferentfrompostoperativevolumewithranksumtest(p<0.01),PreoperativeandpostoperativeEpiduralhaematomavolumesarenotcorrelatedtoGCSwith
6、Spearmancorrelationanalysis(p>0.05).Conclusion:Drillingskullplusurokinasefortreatmentoftraumaticepiduralhaematomaisasafeandeffectivemethod,basedoncorrectlygraspingtheindicationsandcontraindicationsofsurgery.Key:epiduralhaematoma,drillingskull,urokinase硬膜
7、外血肿约占外伤性颅内血肿20%~30%[1],如果诊断与处理不恰当、不及时,直接威胁病人的生命。随着现代影像学与监护设施的发展,对硬膜外血肿患者病情的充分了解,微创治疗硬膜外血肿成为一种简单、有效的手术方法,2007年1月至2010年7月,笔者选取我院30例硬膜外血肿病例,采取微创钻孔引流术,收到了良好的效果,现报告下。1资料与方法1.1临床资料本组硬膜外血肿30例,男22例,女8例,年龄6~72岁,平均locatedintheTomb,DongShenJiabang,deferthenextdayfo
8、cusedontheassassination.Linping,Zhejiang,1ofwhichliquorwinemasters(WuzhensaidinformationisCarpenter),whogotAfewbayonets,duetomissedfatal,whennightcame40.7±18.0岁;受伤原因:车祸20例,打击伤7例,坠落伤3例;急性9例,亚急性18例,慢性3例。临床表现头痛20例,头晕18例,恶心、呕吐