脊柱手术后症状性脊柱硬脊膜外血肿的原因与对策.pdf

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1、312JBengbuMedCoil，March2014，Vo1．39，No．3[文章编号]1000-2200(2014)03-0312-04·临床医学·脊柱手术后症状性脊柱硬脊膜外血肿的原因与对策曾小军[摘要]目的：探讨脊柱手术后症状性脊柱硬脊膜外血肿(SSEH)的发生原因及其对策。方法：回顾性分析脊柱手术后发生SSEH7例(病例组)，选择同一期间、同一医生完成的术后未发生SSEH30例作为对照组，2组术后均使用低分子肝素，术后发生SSEH7例，其中有3例联用低分子肝素和低分子右旋糖酐，5例发生于

2、引流管拔除前。比较2组的年龄、手术节段数、术中失血量及血肿清除前后神经功能评分，分析神经功能恢复与血肿压迫时间及血肿清除前神经功能的关系。结果：2组年龄及手术节段数差异均无统计学意义(P>0．05)，病例组术中失血量明显多于对照组(P<0．01)。神经功能完全恢复与不完全恢复患者血肿压迫时间和血肿清除前感觉评分差异均无统计学意义(P>0．05)，而神经功能完全恢复患者运动评分高于不完全恢复患者(P<0．05)。结论：使用抗凝药物不当、术中失血量大、引流不畅是术后硬脊膜外血肿的危险因素。术后硬脊膜外

3、血肿一旦发生，应尽快处理，解除神经压迫。[关键词]脊柱疾病；脊柱／外科手术；低分子肝素[中国图书资料分类法分类号]R681．5[文献标志码]ACausesandcurativestrategyofsymptomaticspinalepiduralhematomaafterspinesurgeryZENGXiao-jun(DepartmentofSpinalSurgery，RenminHospital，HubeiUnivemi~ofMedicine，Sh@anHubei442000，China)[A

4、bstract]Objective：Tostudythecausesandcurativestrategyofsymptomaticspinalepiduralhematoma(SSEH)afterspinesurgery．Methods：SevenpatientssufferingfromSSEHafterspinesurgerywereincludedinthestudy，and30patientswithnoSSEHafterspinesurgerybytheSaBlesurgeoninth

5、esameperiodactedascontro1．Bothgroupswereadministratedlow—molecular—weight-heparinafteroperation．SevencasesdevelopedSSEHafterthesurgeryandthreeofthemwereadministereddex~an-40combinedwithlow—molecular—weight-heparin；5casesdevelopedSSEHbeforethedrainaget

6、ubeswereremoved．Theageofthepatients，numberoftheoperatedsegmentsandbloodlossduringtheoperationwerecomparedbetweenthetwogroups．Thenervousfunctionscoreandtherecoveryratewerecomparedbetweenthetwo．groupstofindouttheassociationoftherecoveryoutcomewiththedur

7、ationofhematomaandthenervousfunctionbeforethehematomawascleared．Results：Thepatientsageandnumberoftheoperatedsegmentswerenotstatisticallydifferentbetweenthetwogroups(P>0．05)，andtherewasmorebloodlossinthecasegroup(P<0．O1)．ThedurationofsymptomandtheAmeri

8、canSpinalInjuryAssociationSIAsensoryscorebeforehematomaevacuationwerenotstatisticallydiferentbetweenthepatientswithcompleterecoveryoftheneurologicalfunctionandthosewithincompleterecovery(P>0．05)；buttheAmericanSpinalInjuryAssociationmotorscoreo