急诊早期锥颅在急性硬膜外血肿救治中的应用观察

The early emergency cone cranial application in treatment of acute epidural hematoma

目的探讨急诊早期锥颅血肿抽吸减压术在急性硬膜外血肿救治中的应用价值。方法 28例患者行急诊床旁锥颅硬膜外血肿抽吸减压术。根据颅脑C T检查结果,明确血肿位置,以血肿最大层面的中心点作为穿刺点,采用直径约4 m m颅锥由穿刺点锥孔,一次性吸痰管吸除陈旧不凝血,一般吸除血量不超过总积血量的2/3,由锥孔放置一引流管固定,转运神经外科病房进一步治疗。结果在28例行急诊锥颅患者中,有8例患者术前出现一侧瞳孔散大,急诊锥颅后7例瞳孔回缩;1例患者术前有呼吸改变,锥颅后呼吸恢复正常;13例患者术前意识改变,行锥颅后意识恢复;7例患者术前术后无明显改变,其中4例患者因合并骨折等其他多发伤,存在失血性休克。结论急诊早期床边锥颅硬膜外血肿抽吸引流术可有效降低颅内压,减少脑疝发生,为急性硬膜外血肿患者赢得救治时间,方法简单,疗效显著。

ObjectivesDiscussion about the early emergency cone cranial hematoma suction decompression in treatment of acute epidural hematoma.Methods28 cases,patients are carried out sharp bed cone transracial epidural hematoma suction decompression. According to the results of craniocerebral CT examination to the position of hematoma, which is the largest aspect of center of the hematoma as the puncture point,you should use 4 mm in diam cranial cone hole from the puncture point,and get rid of old and nonthrombogenic by the disposable suction tube,that is,it gets rid of more than two-thirds of total amount of hematocele,which should place a drainage tube by fixed taper hole,and shift to neurosurgical ward for further treatment.ResultsIn the 28 cases of the patients with routine emergency cone cranial,8 cases of patients in pre-operation occur one side of mydriasison,and after emergency cone posterior,7 cases of pupil retraction;1 case of patients with pre-operation have breathing changed,breathing returns to normal after cone posterior;13 cases of patients with pre-operation,their consciousness is changed,consciousness appears to restore after cone posterior;no significant changes occurs in 7 cases of patients with pre-operation,4 cases of patients have hemorrhagic shock because of the combined fracture and other multiple trauma.ConclusionEarly emergency bedside cone transracial epidural hematoma smoke attract flow can effectively reduce the intracranial pressure and the decrease of problem of cerebral hernia,what＇s more,it can win over the time to the treatment for acute epidural hematoma,the method is simple and has the significant effect.