侧脑室外引流在救治急性重型原发性颅脑损伤中的应用

Clinical application of external ventricular drainage in acute severe primary brain injury

目的总结快速细孔钻颅侧脑室外引流术治疗无开颅手术治疗指征的急性重型原发性颅脑损伤的临床效果与体会。方法对42例急性重型原发性颅脑损伤患者（特重型24例，重型18例）应用快速细孔钻颅侧脑室外引流救治的临床资料进行回顾性总结分析。结果出院时42例患者中ADL评级达到Ⅰ-Ⅲ级29例（69％），重残（Ⅳ-Ⅴ级）6例（14％），死亡7例（17％）；其中特重型原发性颅脑损伤死亡6例（25％）。结论Dandy’s钻颅需耗时60min左右，且必须在手术室完成；快速细孔钻颅术在患者床边3—5min即可完成，能迅速有效地阻断急性颅内压增高的恶性循环，从而降低重型原发性颅脑损伤致残率及病死率，是急性重型颅脑原发性损伤的有效治疗方法。

Objective To investigate the clinical effect of performing external ventricular drainage using the rapid pore drilling method in acute severe primary brain injury patients. Method A retrospective study of the clinical data of 42 acute severe primary brain injury patients that underwent the rapid pore drilling method. Results There were 29 eases （69%） where ADL level achieved improvement （level I - III）, 6 （14%） cases of severe disability （levellV - V）, and 7 （17%） cases of death. The mortality of patients with a GCS score of 3 -5 was 25%. Conclusion The process of Dandy＇s drilling skull must be operated in the operating room It may take around 60 minutes to finish the entire procedure. However, the rapid pare drilling method only takes about 3 - 5 minutes. It is an effective method that could decrease the ICP rapidly in acute severe primary brain injury patients. It could also reduce the disability rate and death rate. Therefore, the rapid pore drilling method could be an effective therapeutic method in acute severe primary brain injury.