急重型硬膜下血肿术中应用快速硬膜网状切开

Rapid dura--mater reticular incision in acute severe subdural hematoma evacuation

目的研究快速硬膜网状切开在急重型硬膜下血肿开颅手术中的应用价值。方法对惠州市第一人民医院神经外科自2011年1月至2012年6月收治的30例急重型硬膜下血肿患者术中行快速硬膜网格状切开，使硬膜下血肿均匀缓慢排出，达到有效缓解颅高压目的，待血肿排出满意后再常规剪开硬膜继续手术。结果本组患者急性硬膜下血肿均得到满意清除，3个月后格拉斯哥昏迷评分（GCS）评估良好或轻残8例，中残13例，重残或植物状态5例，死亡4例，好转率为70％；术中急性脑膨出的发生率为23．3％（7／30），优于常规方法。结论在急重型硬膜下血肿患者开颅术中快速行硬膜网状切开既能快速清除血肿又能控制性平衡减压．有效降低死残率。

Objective To research the application of rapid dura-mater reticular incision in the evacuation of acute severe subdural hematoma. Methods The clinical data of 30 patients performed evacuation of acute severe subdural hematoma in our hospital were retrospectively analyzed; the dura maters was rapidly incised after the first bore hole being drilled, and then the dura mater was incised in reticular shape after the bone flap was formed. The subdural hematoma could effuse slowly and uniformly, and intracranial hypertension would reduce effectively. Results The subdural hematoma of all patients was removed totally. Based on the Glasgow outcome scale （GOS） scores three months after surgery, 8 patients got recovered, 13 were referred to moderate maim, 5 were severe disability and 4 died. By using this modified method, the acute cenencephalocele rate decreased to 23.3%, which was more effective as compared with that using traditional method （48.2%）. Conclusion In acute severe subdural hematoma operation, reticular incision of dura mater may achieve rapid hematoma evacuation and controllable and balanceable decompression, increase curative rate and decrease mortality.