颅内表皮样囊肿术后迟发出血的护理

Nursing of delayed postoperative hemorrhage in patients with intracranial epidermoid cysts

目的 探讨颅内表皮样囊肿术后迟发出血的临床特点及护理方法。方法 对2002-2012年北京天坛医院行手术治疗的628例颅内表皮样囊肿患者中术后并发迟发出血的31例患者资料进行回顾性分析,分析该并发症的临床特点及其相应的护理措施。结果 颅内表皮样囊肿术后迟发出血发生率为4.9%（31/628）,明显高于同期颅内肿瘤切除术后颅内出血的发生率[0.9%（122/13 479）,P〈0.001]。31例术后迟发出血患者中,男14例,女17例;平均年龄（39岁±20）岁;出血时间发生在术后第5~23天,中位时间为术后第8天。临床表现主要包括颅高压和（或）脑膜刺激征（71.0%）,脑疝（16.1%）,癫痫（9.7%）以及晕厥（3.2%）。11例出现二次出血,二次出血发生率为35.5%（11/31）。25例患者康复出院,其中21例恢复满意,另4例神经功能障碍较前加重;其余6例死亡。结论 颅内表皮样囊肿术后并发迟发出血的时间发生在术后第5~23天,且术后1周左右迟发出血比例较大,出血后二次出血发生率高。在此期间,护理人员应提高对该并发症的警惕,争取早发现,早抢救;出血发生后积极有效的护理,对改善患者的预后具有重要的作用。

Objective To analyze the clinical features and nursing methods of delayed postoperative hemorrhage in patients with intracranial epidermoid cysts. Methods Thirty-one cases with delayed postoperative hemorrhage between 2002 and 2012 in Beijing Tiantan Hospital were retrospectively reviewed. Results The incidence of delayed postopera- tive hemorrhage in patients with epidermoid cyst was 4.9%（31/628）, which was significantly higher than that of postopera- tive hemorrhage in all concurrently treated intracranial tumors[0.9%（122/13 479）, P 〈 0.001]. The group of patients with delayed postoperative hemorrhage were consisted of 14 male and 17 female patients. The patients＇ age ranged from 19 to 55, with the mean age of （39＋20） years old. The time of delayed postoperative hemorrhage ranged from 5th-23th day after removal of the epidermoid cyst, and the median time of onset was the 8th day. The onset manifestation included signs in- tracranial hypertension and（or） meningeal irritation（71.0%）, brain herniation（16.1%）, seizures（9.7%） and syncope（3.2%）. Rehemorrhage occurred in 11 of 31 cases, the incidence of re-hemorrhage was 35.5%. Through clinical care, 25 patients discharged from hospital with 21 cases recovered satisfactorily and 4 aggravated prior to adimission, and the remaining 6 died. Conclusion The interval of delayed postoperative hemorrhage is about 5-23 dafter the removal of epidermoid cyst, most of the hemorrhages occur at about one week postoperatively, and the incidence of rehemorrhage is high, so nurses should be cautious with this complication during this period. Effective nursing after hemorrhage plays an important role in improving the prognosis of patients.