急性硬膜外血肿清除术中低血压8例治疗体会

Hypotention Control during Epidural Hematoma Clearing

目的 探讨急性硬膜外血肿清除术中低血压的原因及处理方法。 方法 对我院 1998年 1月～ 2 0 0 2年 12月收治的 8例急性硬膜外血肿清除术中低血压病人的临床资料进行回顾性分析。结果 8例病人中 7例术前接受脱水药治疗 ,术中收缩压最低时平均 8(0～ 12 )kPa,舒张压最低时平均4 (0～ 8)kPa ,术中平均出血量为 95 0 (80 0～ 2 0 0 0 )ml,术中采用大量快速补液、输血等方法治疗 ;痊愈 3例 ,存在不同程度神经功能障碍 4例 ,死亡 1例。 结论 术前强力脱水致血容量不足、术中出血过多是造成术中低血压的原因。尽量缩短术前准备时间以减少脱水药用量、术中足量补液以及正确的手术方法是减少术中低血压的关键。

Objective To study the cause and treatment of the hypotention during epidural hematoma clearing. Methods 8 cases with hypotention during the epidural hematoma clearing between January 1998 and December 2002 were retrospectively reviewed. Results In 8 cases, 7 received 20% mannitol treatment before operation. The systolic blood pressure reduced to average 8(0～12)kPa, average diastolic pressure was 4(0～8)kPa, and average bleeding in operation was 950(800～2000)ml. Large quantity of liquid and transfusion was supplemented instantly during operation. 3 patients recovered, 4 had nervous disfunction at different degrees, and 1 died. Conclusion Excessive dehydration before operation and a great deal of blood loss were the main causes of hypotention during operation. Reducing the dosage of dehydrant before operation and supplementing enough liquid and transfusion are the keys to reducing the occurrence rate of hypotention during epidural hematoma clearing.