高龄老年人慢性硬膜下血肿的微创手术治疗
[摘要] 目的：总结YL-1型穿刺针微创治疗高龄患者慢性硬膜下血肿(CSDH)的效果。方法：2007 年1 月～2010年8月收治的年龄大于75岁的CSDH患者57例，根据头颅CT采用局麻下血肿腔微创置入YL-1型穿刺针引流，并分次注入尿激酶溶解引流血肿液。并对出院患者进行随访, 总结治疗效果。结果：57例患者均采用微创穿刺术治疗，术后症状即改善，定期复查未见不良反应。结论：运用YL-1型穿刺针微创治疗高龄患者CSDH，均取得较好的治疗效果。
[关键词] 高龄；慢性硬膜下腔血肿；微创穿刺；尿激酶
[中图分类号] R74 [文献标识码]A[文章编号]1674-4721(2011)07(b)-019-02
Minimally invasive surgical drainage in the treatment of chronic subdural hematoma about eld
, 百拇医药
LIN Chonghui, HUANG Xueqin, XU Shengliang, LIN Liangshan, LI Yongsheng
Department of Nerve Surgery, the First Affiliated Hospital of Shantou University Medical College, Guangdong Province, Shantou 515041, China
[Abstract] Objective: To summarize the effect of minimally invasive surgical drainage using a one-time YL-1 type of intracranial Hematoma puncture needle crushing and uokinase technology in the treatment of chronic subdural hematoma about eld. Methods: Total 57 patients of chronic subdural hematom who were above 75 years admited from January 2007 to August 2010, according to head CT scan results, were inserted one-time YL-1 type of intracranial hematoma puncture needle into hematom a cavity under local anesthesia. The hematoma were dissolved and drainage after injection of urokinase into hematoma by YL-1 puncture needle. Patients were followed-up and therapeutic efficacy was summed up after treatment. Results: For the all cases who were treated with minimally invasive surgical drainage, all patients had achieved satisfactory therapeutic effects and no adverse reaction in the periodic inspection. Conclusion: Drainage using minim ally invasive surgery (one-time use of YL-1 type of intracranial hematoma puncture needle grinding and urokinase technology) can achieve a more better therapeutic effect in the treatment of chronic subdural hematoma about the eld.
, 百拇医药
[Key words] Eld; Chronic subdural hematoma; Minimally invasive puncture; Urokinase
慢性硬膜下血肿(chronic subdural hematoma，CSDH)是神经外科常见疾病，该病多发于50岁以上老年人，但随着人类平均寿命的延长，75岁以上的高龄患者也逐步增加。高龄老年患者常合并多种慢性器质性疾病，全身机体代偿能力弱，手术及麻醉耐受性差，易出现心肺并发症。故选择损伤轻微、操作简单、术程短、无需全麻的手术方式成为治疗高龄CSDH 患者的关键。微创穿刺术是目前治疗老年CSDH最简捷安全的一种方式，本科从2007年1月～2010年8月采用微创穿刺术治疗年龄大于75岁的CSDH 患者57例，效果满意。现分析如下：
1 资料与方法
1.1 一般资料
, 百拇医药
本组57例，男31例，女26例。年龄75～85岁，平均79岁，80岁以上28例。明确头部外伤史41例。冠心病史 6 例，心肌梗死病史 2例，高血压病史43 例；肺心病、肺气肿病史 5 例，双侧 CSDH 9 例，单侧48 例。主要临床表现：有头昏、头痛、肢体乏力、智力下降等。头颅CT检查示：CSDH大多位于额颞顶部，少数延及枕部。血肿量60～200 ml，多为80～150 ml。
1.2 治疗方法
57例高龄患者均在手术室局麻下进行微创手术治疗。采用YL-1型(北京万特福公司生产)一次性颅内血肿穿刺针，术前据CT定位，选取最佳穿刺点及合适型号穿刺针，常规消毒局麻，用专用电钻将血肿穿刺针快速穿透颅骨、硬膜进入血肿腔；连接侧管，先缓慢放出10～30 ml血肿液，后任其自然引流，同时观察患者意识及瞳孔变化，能言语者询问是否出现头痛不适等症状。待侧管无血液流出后用0.9%氯化钠溶液反复冲洗，每次2～5 ml，等量置换至冲洗液基本澄清为止；如引流管中含血凝块较多，则加用尿激酶20 000 U冲洗，必要时变换头部位置，待冲洗液基本清亮时接无菌引流袋持续闭式引流。术后患者去枕平卧，头稍偏向患侧、不用脱水剂，根据患者心肺功能情况适当增加静脉补液量或多饮水，以促使脑组织复位及血肿腔闭合；如术后引流管中血凝块较多，则予血肿腔内注入用0.9%氯化钠溶液2ml稀释的尿激酶20 000 U，夹闭引流管2～4 h后开放引流，每日1～2次。术后2～3 d复查头颅CT，如CT提示血肿腔基本闭合且引流液呈淡黄色、引流量显著变少(<10 ml/d)，则拔出微创针，头皮创口予缝合1针。
2 结果
本组57例患者均一次穿刺成功，经治疗后所有患者症状明显改善。留置穿刺针3～5 d，平均4 d。无一例死亡，出现低颅压3例，非张力性气颅5例，予保守治疗后症状消失；均未出现张力性气颅、颅内感染或再出血等并发症。术后1～4个月复查CT，其中血肿全部消失、脑组织完全复位者42例，患侧残留薄层硬膜下积液11例，双侧薄层硬膜下积液4例，均未行特殊处理，定期复查未见不良反应。, 百拇医药(林重辉,黄雪钦,徐声亮,林良山,黎永胜)
[关键词] 高龄；慢性硬膜下腔血肿；微创穿刺；尿激酶
[中图分类号] R74 [文献标识码]A[文章编号]1674-4721(2011)07(b)-019-02
Minimally invasive surgical drainage in the treatment of chronic subdural hematoma about eld
, 百拇医药
LIN Chonghui, HUANG Xueqin, XU Shengliang, LIN Liangshan, LI Yongsheng
Department of Nerve Surgery, the First Affiliated Hospital of Shantou University Medical College, Guangdong Province, Shantou 515041, China
[Abstract] Objective: To summarize the effect of minimally invasive surgical drainage using a one-time YL-1 type of intracranial Hematoma puncture needle crushing and uokinase technology in the treatment of chronic subdural hematoma about eld. Methods: Total 57 patients of chronic subdural hematom who were above 75 years admited from January 2007 to August 2010, according to head CT scan results, were inserted one-time YL-1 type of intracranial hematoma puncture needle into hematom a cavity under local anesthesia. The hematoma were dissolved and drainage after injection of urokinase into hematoma by YL-1 puncture needle. Patients were followed-up and therapeutic efficacy was summed up after treatment. Results: For the all cases who were treated with minimally invasive surgical drainage, all patients had achieved satisfactory therapeutic effects and no adverse reaction in the periodic inspection. Conclusion: Drainage using minim ally invasive surgery (one-time use of YL-1 type of intracranial hematoma puncture needle grinding and urokinase technology) can achieve a more better therapeutic effect in the treatment of chronic subdural hematoma about the eld.
, 百拇医药
[Key words] Eld; Chronic subdural hematoma; Minimally invasive puncture; Urokinase
慢性硬膜下血肿(chronic subdural hematoma，CSDH)是神经外科常见疾病，该病多发于50岁以上老年人，但随着人类平均寿命的延长，75岁以上的高龄患者也逐步增加。高龄老年患者常合并多种慢性器质性疾病，全身机体代偿能力弱，手术及麻醉耐受性差，易出现心肺并发症。故选择损伤轻微、操作简单、术程短、无需全麻的手术方式成为治疗高龄CSDH 患者的关键。微创穿刺术是目前治疗老年CSDH最简捷安全的一种方式，本科从2007年1月～2010年8月采用微创穿刺术治疗年龄大于75岁的CSDH 患者57例，效果满意。现分析如下：
1 资料与方法
1.1 一般资料
, 百拇医药
本组57例，男31例，女26例。年龄75～85岁，平均79岁，80岁以上28例。明确头部外伤史41例。冠心病史 6 例，心肌梗死病史 2例，高血压病史43 例；肺心病、肺气肿病史 5 例，双侧 CSDH 9 例，单侧48 例。主要临床表现：有头昏、头痛、肢体乏力、智力下降等。头颅CT检查示：CSDH大多位于额颞顶部，少数延及枕部。血肿量60～200 ml，多为80～150 ml。
1.2 治疗方法
57例高龄患者均在手术室局麻下进行微创手术治疗。采用YL-1型(北京万特福公司生产)一次性颅内血肿穿刺针，术前据CT定位，选取最佳穿刺点及合适型号穿刺针，常规消毒局麻，用专用电钻将血肿穿刺针快速穿透颅骨、硬膜进入血肿腔；连接侧管，先缓慢放出10～30 ml血肿液，后任其自然引流，同时观察患者意识及瞳孔变化，能言语者询问是否出现头痛不适等症状。待侧管无血液流出后用0.9%氯化钠溶液反复冲洗，每次2～5 ml，等量置换至冲洗液基本澄清为止；如引流管中含血凝块较多，则加用尿激酶20 000 U冲洗，必要时变换头部位置，待冲洗液基本清亮时接无菌引流袋持续闭式引流。术后患者去枕平卧，头稍偏向患侧、不用脱水剂，根据患者心肺功能情况适当增加静脉补液量或多饮水，以促使脑组织复位及血肿腔闭合；如术后引流管中血凝块较多，则予血肿腔内注入用0.9%氯化钠溶液2ml稀释的尿激酶20 000 U，夹闭引流管2～4 h后开放引流，每日1～2次。术后2～3 d复查头颅CT，如CT提示血肿腔基本闭合且引流液呈淡黄色、引流量显著变少(<10 ml/d)，则拔出微创针，头皮创口予缝合1针。
2 结果
本组57例患者均一次穿刺成功，经治疗后所有患者症状明显改善。留置穿刺针3～5 d，平均4 d。无一例死亡，出现低颅压3例，非张力性气颅5例，予保守治疗后症状消失；均未出现张力性气颅、颅内感染或再出血等并发症。术后1～4个月复查CT，其中血肿全部消失、脑组织完全复位者42例，患侧残留薄层硬膜下积液11例，双侧薄层硬膜下积液4例，均未行特殊处理，定期复查未见不良反应。, 百拇医药(林重辉,黄雪钦,徐声亮,林良山,黎永胜)