迟发性外伤性颅内血种的临床特点及预后因素

目的 研究迟发性外伤性颅内血种（DTIH）的临床特点及预后因素。方法 回顾性分析了66例DTIH病人的临床资料。结果 DTIH常见于男性中老年减速性损伤，以额颞部最多，常发生于伤后72h；意识障碍进行性加重，逐渐出现局限性神经症状及局限性癫痫是其三个重要症状；低血压为促发因素。原发性脑损伤重，年龄超过60岁，诊断时间超过24h，术前GCS评分小于8分死亡率高。结论 DTIH的临床表现具有其特点，正确认识该病、及时复查CT是早期诊断的关键；原发性脑损伤的程度、年龄、瞳孔变化、确诊时间、术前意识水平是影响其预后的主要因素。

Clinical Characteristicsand Prognostic Factors of Delayed Traumatic Intracranial Hematoma

Objective To study the clinical characteristics and prognostic factors of delayed traumatic intracranial hematoma(DTIH). Method Clinical data of 66 patients with DTIH was analyzed retrospectively. Results DTIH often occurred within 72 hours after retardation head injury in the middle-aged and old men. It located most frequently in the frontotemporal site. Progressive deterioration of conciousness, gradual appearance of local neurological symptoms and focal epilepsy were the three main symptoms of DTIH, which was facilitated by hypotension. High mortality was usually seen in the patients over sixty, who suffered from severe primary brain injury (preoperative GCS>8), or whose DTIH was diagnosed over 24 hours following its occurrence. Conclusions DTIH has its distinct clinical characteristics. Serial CT scans may be helpful to making early diagnosis. The age of patients, severity of the brain injury, preoperative level of conciousness and DTIH diagnosis time were the main factors influencing the prognosis of the patients.