经皮穿刺结合开颅手术救治创伤性特急性颅内血肿

Percutaneous puncture and craniotomy for hyperacute traumatic intracranial hematoma

目的总结经皮穿刺结合开颅手术救治创伤性特急性颅内血肿的经验。方法采用经皮穿刺结合开颅减压手术对12例创伤性特急性颅内血肿的患者进行救治，其中硬膜下血肿7例，硬膜外血肿3例，硬膜外合并硬膜下血肿2例；术前双侧瞳孔散大6例，单侧瞳孔散大6例，呼吸改变8例。入院GCS3分4例，4分6例，7分2例。结果穿刺后9例患者瞳孔有不同程度回缩，7例患者自主呼吸转平稳。手术后24h内死亡2例，24h后死亡4例，生存6例。随访6个月～2年。GOS评分良好4例，植物生存2例，死亡6例。结论经皮穿刺结合开颅手术是救治特急性颅内血肿的一种行之有效的方法。

Objective To discuss the experiences in successful treatment of hyperacute traumatic intracranial hematoma with percutaneous puncture and craniotomy. Methods Percutaneous puncture and craniotomy was performed in 12 patients with hyperacute traumatic intracranial hematomas including seven with subdural hematoma, three with epidural hematoma and two with episubdural hematoma. Before operation, there found enlargement of bilateral pupil in six patients, enlargement of unilateral pupil in six and changed breathing rhythmicity in eight. Glasgow Coma Scale （GCS） was 3 points in four patients, 4 points in six and 7 points in two. Results After percutaneous puncture, enlarged pupil was retracted at different degrees in nine patients and spontaneous breathing conditions improved in seven. After craniotomy, two patients died within 24 hours, four died after 24 hours but six patients survived. The follow-up for 0.5-2 years showed four patients with sound Glasgow Outcome Score, two at vegetative state and six deaths. Conclusion Percutaneous puncture combined with craniotomy is an effective way for hyperacute intracranial hematoma.