经前囟静脉留置针穿刺治疗婴儿外伤性硬膜下血肿.docVIP

经前囟静脉留置针穿刺治疗婴儿外伤性硬膜下血肿【摘要】 目的 介绍经前囟密闭式静脉留置针穿刺联合尿激酶注入引流治疗婴儿外伤性硬膜下血肿,探讨以静脉留置针经前囟穿刺引流在婴儿外伤性硬膜下血肿治疗中的临床应用及治疗效果。方法 以管径0.7 mm密闭式静脉留置针于血肿侧前囟外侧角穿刺,接引流管持续引流,并间断注入尿激酶碎溶血肿以利引流,引流3~7 d后拔管。结果 经前囟静脉留置针穿刺引流治疗婴儿外伤性硬膜下血肿操作简单、创伤小、避免张力性气颅、感染率低、医疗费用低,治愈率高等优点,有临床实用价值。 【关键词】婴儿外伤性硬膜下血肿;前囟;尿激酶;静脉留置针 IV cathter system stabs into anterior fontanel which is used in therapy infantile traumatic subdural hematoma GUO Yu-chen,LV Xiao-fei,XIA Kai,et al.Department of Neurosurgery,the Second Peoples Hospital of Liaocheng,Linqing 252600,China 【Abstract】 Objective To introduce closed IV cathter system stabs into anterior fontanel associated withurokinase injection which is used in therapy infantile traumatic subdural hematoma,and then analysis its clinical application and curative effect.Methods Stab the lateral angle of anterior fontanel aside of hematoma with 0.7 mm closed IV cathter system,connect with a tube draining consecutively,inject urokinase interruptablely,and then extubate in 3~7 days.Results This is a simple and micro-impaired means in therapy infantile traumatic subdural hematoma,it is also some other advantages such as avoiding tension pneumocephalus、low infection rate、low health care cost、high cure rate etc,and has practical value. 【Key words】Infantile traumatic Subdural hematoma;Anterior fontane;Urokinase;IV cathter system 婴儿外伤性硬膜下血肿在外伤中并非少见,部分硬膜下血肿患儿经保守治疗可取得良好效果,一旦出现明显颅高压症状则应施行手术治疗,传统的钻孔引流或开颅手术创伤大,风险高。我院近几年采用经前囟静脉留置针穿刺持续引流治疗婴儿外伤性硬膜下血肿具有手术时间短,创伤小,安全,医疗费用低,降低感染风险等优点,取得满意疗效,具有一定临床实用价值。 1 资料与方法 1.1 一般资料 2000年8月至2010年2月我院共收治有手术指征的外伤性硬膜下血肿患儿35例,年龄2~12个月,均有头部外伤史,其中坠落伤28例,产伤7例。以呕吐、精神萎靡、癫痫为主要症状,查体前囟张力均明显增高,脑搏动明显减弱或消失,伴头围明显增大者3例。所有病例均行头颅CT扫描确诊为硬膜下血肿。急性期(3 d内)5例、非急性期(3 d)30例。合并硬膜下积液16例,均位于额颞顶部。合并脑挫裂伤或脑内血肿8例,偏瘫5例,基底节区脑梗死2例,颅骨骨折10例。29例为单侧,6例为双侧。 1.2 方法 患儿外伤后均行颅脑CT检查示硬膜下血肿,前囟张力明显增高,且出现一系列临床症状,完善术前检查无明显手术禁忌,于病房换药室行手术治疗,备皮,患儿取仰卧位,局部麻醉成功后。用管径0.7 mm密闭式静脉留置针于血肿侧前囟外侧角穿刺,穿刺点距矢状线至少2.0 cm,以避开矢状窦和皮质静脉,与头皮适度倾斜,使针头于皮下潜行少许,以避免因为婴儿头皮较薄硬膜下血肿自穿刺道漏出。针尖突破硬脑膜后有落空感,见有陈旧血性液体流出后,边拔除针芯,边进针套约1.