急性硬脑膜下血肿合并脑疝66例救治体会

Experience of with cerebral hernia of acute subdural hematoma plus 66 cases report

目的：探讨创伤性急性硬脑膜下血肿合并脑疝患者的急救措施。方法对66例发生脑疝的急性硬脑膜下血肿患者，首先利用YL-1型颅脑穿刺针行血肿穿刺初步减压，然后行开颅血肿清除去骨瓣减压术。结果伤后6个月-1年进行随访，按格拉斯哥预后评分（GOS）评估疗效，66例患者良好23例，中残13例，重残9例。植物状态生存4例，死亡17例（其中有4例退院后于24h内死亡）。结论及时解除脑疝，降低颅压，去除占位是成功抢救合并脑疝的急性硬脑膜下血肿患者的关键。及早利用YL-1型颅脑穿刺针行血肿穿刺减压，可以为进一步行开颅血肿清除、去骨辩减压手术争取时间，在提高抢救成功率方面起到决定性作用。

Objective To explore the treatment measures of cerebral hernia of acute subdural hematoma. Methods YL-1 puncture needle was used to partly drain the hematoma in the emergency room in 66 patients with cerebral hernia of acute subdural hematoma before the removal of the hematoma and osseous flap through craniotomy. Results GOS was used to evaluate the efficacy at 6 to 12 month follow-up. 23 cases got good results,13 moderate disability,9 severe disability and 4 vegetable condition. 17 cases died in this study.Condusion The application of drainage of the hematoma with YL-1 puncture needle in combination with the decompression measure through the removal of the left hematoma and the osseous flap is necessary in the treatment of the patients with cerebral hernia of acute subdural hematoma