[1]杜　威　姚国杰　韦　可　伍　杰　李　明　龚　杰　徐国政　杨　铭　马廉亭.重型颅脑损伤术后凝血功能障碍病人残留血肿或迟发性颅内出血的处理[J].中国临床神经外科杂志,2019,(08):457-460.[doi:10.13798/j.issn.1009-153X.2019.08.003]
　DU Wei,YAO Guo-jie,WEI Ke,et al.Treatment of residual hematoma or delayed intracranial hemorrhage after decompressive craniectomy in patients with severe traumatic brain injury complicated with coagulopathy[J].,2019,(08):457-460.[doi:10.13798/j.issn.1009-153X.2019.08.003]
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重型颅脑损伤术后凝血功能障碍病人残留血肿或迟发性颅内出血的处理()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2019年08期
页码:
457-460
栏目:
论著
出版日期:
2019-08-25

文章信息/Info

Title:
Treatment of residual hematoma or delayed intracranial hemorrhage after decompressive craniectomy in patients with severe traumatic brain injury complicated with coagulopathy
文章编号:
1009-153X（2019）08-0457-04
作者:
杜　威　姚国杰　韦　可　伍　杰　李　明　龚　杰　徐国政　杨　铭　马廉亭
430070 武汉，中国人民解放军中部战区总医院神经外科（杜　威、姚国杰、韦　可、伍　杰、龚　杰、徐国政、杨　铭、马廉亭）；430081 武汉，武汉科技大学医学院（李　明）
Author(s):
DU Wei1;  YAO Guo-jie1;  WEI Ke1;  WU Jie1;  LI Ming2;  GONG Jie1;  XU Guo-zheng1;  YANG Ming1;  MA Lian-ting1.
1. Department of Neurosurgery, General Hospital, Central Theater, PLA, Wuhan 430070, China; 2. Medical School, Wuhan University of Science and Technology, Wuhan 430022, China
关键词:
型颅脑损伤; 凝血功能障碍; 残留血肿; 迟发性颅内出血; 软通道置管引流术; 颅内压监测
Keywords:
Severe traumatic brain injury;  Decompressive craniectomy;  Coagulopathy;  Residual hematoma;  Delayed intracranial hemorrhage;  Soft-channel drainage;  Intracranial pressure mornitoring
分类号:
R 651.1+5; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2019.08.003
文献标志码:
A
摘要:
目的 探讨重型颅脑损伤术后凝血功能障碍病人残留血肿或迟发性颅内出血的处理对策。方法 回顾性分析2016年1月至2018年9月收治的29例重型颅脑损伤开颅术后病人的临床资料。所有病人术中均行颅内压传感器植入监测颅内压，术后凝血功能障碍并有残留血肿或迟发性颅内血肿。17例采用软通道置管引流术治疗（引流组），12例采用保守治疗（对照组）。结果 引流组术后ICP呈明显下降趋势（P<0.05），而且明显低于对照组（P<0.05）。引流组NICU住院时间、甘露醇用量及使用时间较对照组均明显减少（P<0.05），而且引流组再次开颅手术率、肾功能损害发生率和电解质紊乱发生率均明显低于对照组（P<0.05）。两组颅内感染发生率、肺部感染及术后6个月GOS评分均无统计学差异（P>0.05）。结论 软通道置管引流术简单易行，创伤小，手术时间短，适用于重型颅脑损伤术后凝血功能障碍并有残留血肿或迟发性颅内血肿的病人，可以有效的降低颅内压、减少并发症，但需严格掌握手术适应证。
Abstract:
Objective To explore the treatment of residual hematoma or delayed intracranial hemorrhage after decompressive craniectomy in patients with severe traumatic brain injury (sTBI) complicated with coagulopathy. Methods The clinical data of 29 patients with sTBI who underwent decompressive craniectomy from January 2016 to September 2018 were analyzed retrospectively. The intracranial pressure sensor was implanted to monitor the intracranial pressure during the deconpression in all the patients. The blood coagulation dysfunction and residual hematoma or delayed intracranial hematoma occurred in all the patients after the decompression. Of 29 patients, 17 patients were treated with soft-channel drainage (drainage group) and 12 received conservative treatment (control group). Results The ICP in the drainage group significantly decresed after the decompression (P<0.05), and it was significantly lower than that in the control group (P<0.05). The hospital stay time, the dosage and the use time of mannitol in the drainage group were significantly lower than those in the control group (P<0.05). The incidences of the renal dysfunction and electrolyte disturbance were significantly lower than those in the control group (P<0.05). There was no statistical difference in the incidence of intracranial infection, pulmonary infection and GOS score 6 months after operation between both the groups (P>0.05). Conclusions The soft-channel drainage, which has many advantages such as simple, easy, small wound, and short operation time, can effectively reduce the intracranial pressure and reduce the complications in the sTBI ptaients complicated with coagulopathy and residual hematoma or delayed intracranial hematoma, but it is necessary to strictly control the operation indications.

参考文献/References:

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备注/Memo

备注/Memo:
（2019-07-10收稿，2019-07-18修回）
更新日期/Last Update: 2019-08-25