目的 评估方体定向置管治疗创伤性非功能区硬膜外小血肿的疗效。方法 回顾分析65例创伤性非功能区硬膜外血肿患者,血肿量在15～30 mL。依据治疗方法分为2组,35例对照组患者采用传统药物治疗而30例观察组患者同时采用药物及方体定向置管治疗。对比分析2组患者住院期间血肿清除率及并发症发生率,术后3个月及6个月时再发头痛、焦虑及血肿清除的情况。结果 两组相比,观察组患者血肿清除率(66.7%),高于对照组(25.7%),两组差异有统计学意义,而并发症发生率,两组无统计学差异;3个月后再发头痛、焦虑及硬膜外血肿清除的情况存在显著差异;而6个月后上述情况无显著差异。结论 方体定向置管治疗在不增加患者并发症发生的同时,能在短时间内快速清除硬膜外血肿,降低患者伤后近期头痛、焦虑症状的发生,改善患者近期生活质量,具有一定临床应用的价值。

Objective To evaluate the clinic value the technique of Cuboid stereotactic catheter (TCSC) in the treatment of small-volume traumatic extradural hematoma in non-functional areas.Methods We performed a retrospectively analysis of 65 patients with small-volume(15-30 mL) traumatic extradural hematoma in non-functional areas. All of which were divided into two groups according to the different treatments. 35 cases treated with drugs were control group, while the rest of 30 cases with both drugs and TSCS were treatment group. The complication incidence and hematoma clearance rate in hospitalization time, recurrence rate of headache, anxiety,hematoma clearance rate at 3 and 6 months follow-up were compared between the two groups.Results The hematoma clearance rate in control group and treatment group were 25.7% and 66.7%,respectively. (P=0.001), while the complication rate was no obvious differences. The recurrence rate of headache, anxiety and hematoma clearance rate at 3 months follow-up were different between the two groups. These conditions were not happened at 6 months follow-up.Conclusion TCSC may eliminate the hematoma within a short hospitalization time by avoiding extra complication coincidence, improve the short-term life quality of patients such as relief the symptoms like headache and anxiety in the patients with small-volume(15~30 mL) traumatic extradural hematoma in non-functional areas. Above of results indicates the impact of this technique on neurosurgical practice.

       目的   探讨、对比休克指数（SI）与血乳酸水平预测院前创伤性休克患者预后中的应用。方法   于2020年12月—2023年12月收治80例创伤性休克患者，均接受SI、乳酸水平的监测。结合监测的结果进行分组：乳酸正常组：乳酸水平在2 mmol/L以下，升高组：2 mmol/L以上；SI正常组：SI在0.9以下，升高组：SI在0.9以上。观察、记录患者入院7 d后的序贯性器官功能衰竭评分（SOFA），对多器官功能障碍综合征（MODS）情况进行评估。同时观察、记录机械通气、血管活性药物的使用和住院等情况。结果   乳酸水平升高组60例，正常组20组；SI升高组58例，正常组22例，女性乳酸水平、SI，与男性比较差异无统计学意义（P＞0.05）。是否发生多器官功能障碍者的年龄、性别、SI指数比较差异无统计学意义（P＞0.05）；格拉斯哥昏迷评分（GCS）评分［（4.22±1.53）分 vs （9.46±3.82）分，t=7.816，P＜0.001］、住院时间［（23.34±5.71）d vs （12.26±2.11）d，t=11.830，P＜0.001］、基础乳酸值［（4.75±2.36）mmol/L vs （2.04±1.11）mmol/L，t=6.721，P＜0.001］与发生MODS在组间对比差异有统计学意义。SI升高组的容量复苏收缩压＞80 mmHg（%）有27例，与乳酸水平升高组比较差异有统计学意义（P＜0.05）（46.55% vs 18.18%，χ ² =12.237，P＜0.001）。乳酸水平升高组中，11例患者接受机械通气，乳酸水平均升高（P＜0.05）；9例患者使用血管活性药物，乳酸水平均升高，比较差异无统计学意义（P＞0.05）；38例住院患者，24例乳酸水平升高（P＜0.05）。13例患者接受机械通气，12例SI升高，比较差异无统计学意义（P＞0.05）；11例患者接受血管活性物治疗，8例SI升高，比较差异无统计学意义（P＞0.05）；39例患者住院，SI升高22例，比较差异有统计学意义（P＜0.05）。结论   针对重症的创伤性休克患者，当血乳酸水平升高时会大大增加MODS发生的概率，乳酸水平在对重症创伤性休克患者预后进行预测时，应用价值更高。

       Objective  To explore and compare the application of shock index（SI）and  blood lactic acid level in predicting the prognosis of patients with pre-hospital traumatic shock．Methods  From December 2020 to December 2023，80 patients with traumatic shock were enrolled，and their SI and levels of lactic acid were monitored．Patients were grouped according to the monitoring results：normal group：lactic acid level below 2 mmol/L，increased group：above 2 mmol/L；normal group：SI below 0.9，and increased group：SI above 0.9．The sequential organ failure score（SOFA）was observed and recorded 7 days after hospitalization，and the situation of multiple organ dysfunction syndrome（MODS）was evaluated．At the same time，mechanical ventilation，the use of vasoactive substances and hospitalization were observed and recorded．Results  There were 60 cases in the group with increased lactic acid level and 20 cases in the normal group．There were 58 cases of increased SI and 22 cases of normal．The lactic acid level and SI index in women were higher than those in men，with no difference（P＞0.05）．There were no differences in age，sex，SI index and the incidence of MODS（P＞0.05）．GCS score（4.22±1.53 vs 9.46±3.82），hospitalization days（23.34±5.71 vs 12.26±2.11）d，basal lactate value（4.75±2.36 vs 2.04±1.11）mmol L-1 were significantly different from those of MODS（t=11.830，P＜0.001；t=6.721，P＜0.001，P＜0.05）．There were 27 cases with volume  resuscitation systolic blood pressure ＞ 80 mmhg（%）in the group with increased SI，which was different from that of SI and lactic acid（46.55% vs18.18%，χ ² =12.237，P＜0.001；P＜0.05）．Lactic acid increased group：11 patients received mechanical ventilation，and the lactic acid levels of all 11 patients increased（P＜0.05）．Nine patients used vasoactive substances，and their lactic acid levels all increased，with no significant difference（P＞0.05）．Of the 38 inpatients，24 cases had elevated lactic acid levels（P＜0.05）．Thirteen patients received mechanical ventilation，and 12 patients had elevated SI，with no statistical significance（P＞0.05）．Eleven patients were treated with vasoactive agents，and 8 patients had increased SI，with no difference（P＞0.05）．Among the 39 patients hospitalized，22 cases had increased SI，and the difference was statistically significant（P＜0.05）．Conclusions  For patients with severe traumatic shock，when the blood lactic acid level increases，the probability of MODS will be greatly increased．Compared with SI index，lactic acid level has higher application value in predicting the prognosis of patients with severe traumatic shock．