慢性硬膜下血肿行钻孔引流术后引流不畅原因分析

Analysis of the causes of inadequate drainage of chronic subdural hematoma after drilling

目的分析慢性硬膜下血肿行钻孔引流术后引流不畅的原因以及防治措施。方法回顾性分析2008年6月一2013年7月我院11例慢性硬膜下血肿钻孔引流后出现引流不畅病例的临床资料并进行总结。包括患者症状、CT表现、引流不畅的原因、处理的措施及愈合等。结果因纤维分隔物、纤维蛋白降解产物堵塞引起引流不畅4例;引流管"打折"、侧孔被血肿包膜包绕4例;血凝块堵塞2例;颅内压下降过快1例。本组病例无严重并发症。结论采用灌注尿激酶、调整引流管角度和深度、适当补液、调整患者头位等处理措施可以提高引流效果,改善患者预后。

Objective To analysis the causes of inadequate drainage of chronic subdural hematoma（CSDH） after drilling and propose treatment measures. Methods The clinical data of 11 patients with CSDH occurred poor drainage after drilling were analyzed retrospectively. Its clinical manifestations, CT scanning, inadequate drainage causes, treatment measures and outcome were summarized. Results Fiber separator and fibrin degradation product blocked drainage tube in 4 patients, tube angulation and haematoma membrane blocked drainage tube in 4, bleeding clot in 2 and intraeranial pressure decreased rapidly in 1. There was no severe complications. Conclusion Urokinase perfusion through drainage tube, adjustment of the angle and depth of drainage tube, appropriate fluid infusion, adjustment of the head position can improve the effects of drainage and the prognosis.