影响慢性硬膜下血肿钻孔引流术治疗效果的因素

Analysis of the Factors Influencing Curative Effect of Burr-hole Irrigation of Chronic Subdural Hematom

目的 :总结分析影响慢性硬膜下血肿钻孔引流术治疗效果的因素 .方法 :12 0例病人随机分为两组 :对照组和试验组 ,每组 6 0例 .每组中 30例病人行血肿腔上方钻孔引流术 ;另 30例病人行血肿腔下方钻孔引流术 ;术后 :2～ 4d拔除引流管 .试验组术后给予不吸氧 ,采用头低脚高位 (约 30°)头侧睡向患侧的体位、日补液 35 0 0mL、憋气训练 (如 :吹气球 )等促脑膨胀治疗 .全组病人均于术后 3d及术后 15d复查CT ,比较两组病人的治疗效果 .结果 :12 0例病人中发生张力性气颅死亡 1例 ;术中发生癫痫 1例 ;试验组病人发生硬膜下积气 4例、硬膜下积液 4例、再次出血 1例、血肿残余者 1例 ;对照组病人发生硬膜下积气 5例、硬膜下积液 9例、再次出血 1例、血肿残余者 2例 .结论 :血肿腔上方钻孔引流术和血肿腔下方钻孔引流术疗效无差别 ,年龄、身体健康状况、术中排气是否彻底。

Objective: To analyze and sum up the main factors of affecting burr-hole irrigation of chronic subdural hematoma. Methods: 120 cases were divided into two groups , the operated group and the control group, and each group 60 cases. The hole going to the hematoma was adapted to 30 cases of the test group; and the hole blowing to the hematoma for others. The irrigation pipes of all patients were pulled out in 1?d and 4?d. Following the option, patients of the test group without supplied oxygen, lying on a place head below feet (30°) and head sleeping to worry side, given 3?500?mL liquid through vein daily, taking choke with resentment (eg. blow balloon). All patients were called back for CT in 3?d and 15?d, and the results of different options between two groups were compared. Results: 1 case of all patients died because of pneumocephalus, 1 case happened epilepsy. 4 cases of the test group happened subdural gas, 4 cases subdural fluid, 1 case subdural hemorrhage again, 1 case subdural hematoma remained; 5 cases of the other one happened subdural gas, 9 cases subdural fluid, 1 case subdural hemorrhage again, 2 cases subdural hematoma remained. Conclusion: The option in which the hole was bored up to the hematoma was equaled the other one in which the hole was bored down to the hematoma. Age, position of the hole, whether the hematoma to be located and the treatment for brain inflating were the important factors affecting curative effects.