急诊锥颅减压抢救重症外伤性硬膜外血肿

Emergent decompression by burr-hole drainage to treat severe traumatic epidural hematoma

目的 探讨床旁急诊锥颅减压抢救重症外伤性硬膜外血肿的临床价值。方法 1994年1月至2000年10月以床旁急诊锥颅减压抢救急性外伤性硬膜外血肿致脑疝病人53例。结果 锥颅后均有暗红色血凝块溢出 ,量为20～80ml,平均55ml。减压后患侧或对侧瞳孔缩小 ,甚至正常 ,对光反射恢复 ,昏迷程度变浅25例 ;患侧或对侧瞳孔缩小或病理性呼吸转正常 ,而昏迷程度不变者17例 ;患者瞳孔及昏迷程度无变化9例 ;出现失血性休克昏迷程度加深者2例。结论 急诊锥颅减压术为伤性硬膜外血肿所致脑疝的进一步抢救治疗赢得宝贵时间 ,此法简单、快速、有效 。

Objective To evaluate the effects of bedside emergent decompression by burr-hole drainage to treat severe traumatic epidural hematoma. Methods From 1994 to October 2000, 53 cases with cerebral hernia induced by acute traumatic epidural hematoma were treated with this operation in the emergency. Results 20～80ml (mean 55ml) sludged blood was drained from hematoma in each cases. 25 cases showed neurologic improvment, with shrinkage of dilated pupil and recovery of light reflex. Dilated pupil became shrank and pathological breath became normal in 17 cases, but without changes of mental status. Hemorrhagic shock occurred in 2 cases with worsen neurologic symptoms. Conclusion Emergent decompression by burr-hole drainage was simple, rapid and efficient in treating traumatic epidural hematoma and gained time to manage cerebral hernia. That was of great practical value.