B型超声波在颅脑损伤术中及术后的应用研究

The application of B-type ultrasonic in craniocerebral injury and post operation

目的 应用B超在颅脑损伤术中探查多发性血肿并导向手术,对术后危重病人进行床旁监测。方法 应用超声显像仪,对术中急性脑膨出,疑有多发性颅内血肿者实时术中B超扫查,开颅后在血肿清除部位彻底止血,将探头用无菌乳胶膜包裹,进行多角度多层面扫查。术后则经骨缺损区或颅骨钻孔处进行水平、冠状、矢状或滑行扫查。结果 术中扫查54例,不同部位的颅内血肿或积血42例,同侧脑内血肿6例,脑挫裂伤脑水肿6例。B超引导下手术清除血肿42例,术后50例进行了CT检查,损伤部位和范围与B超及手术发现基本一致。术后检查118例。其中114例经CT扫描检查,总体符合率为74.56％,与CT参照对比P>0.05。结论 术中B超扫查对多发性颅内血肿能准确定位,对明确术中急性脑膨出的原因具有重要意义,术后经骨缺损对迟发性血肿能准确检出,对脑挫伤,脑水肿的扫查无意义。

Objective To monitor multiple intracramal hematomas and navigate operation after craniocerebral injury with B-type ultrasonic. The postoperative critical patients were monitored in bed as well. Methods The patients skeptical of multiple intracranial hematomas for acute encephalocele in surgery were monitored by B-type ultrasonic and thorough hemastasis was done in part of hematomas after opening skull. With the detecting head wrapped with sterile lacteprene webbing, the lesions were scanned at different layers and angles. After operation, the lesions in the patients were scanned with B-type ultrasonic through the skull defects or the hole horizontally, coronally, arrow-like or even slipping. Results 54 cases were examined in the course of operation: 42 cases had intracranial hematomas at different intracranial positions, 6 cases had intracranial hematomas on the same side and another 6 cerebral contusion and laceration or cerebral edema. 42 cases received operations under the navigation of B-type ultrasonic and 50 cases were examined with CT after operation, showing the same results in view of locations and size of lesions as B-type ultrasonic did. After operation, 114 of 118 cases were re-examined with CT, showing the total coincidence rate reached 74.56% (P>0.05). Conclusion B-type ultrasonic is accurate at the navigation and localization of multiple intracranial hematomas in operation, therefore, key to identifying the causes of acute encephalocele. Scanning with B-type ultrasonic through skull defects is accurate in checking late hematomas after operation, but insignificant for contusion and laceration or cerebral edema.