外伤性迟发硬膜外血肿的临床机制及预后探讨

目的：探讨外伤性迟发硬膜外血肿发生的临床机制和影响其预后的临床指标。方法：回顾性分析45例经CT和临床观察确诊的外伤性迟发硬膜外血肿的临床资料。结果：41例迟发硬膜外血肿发生于伤后72h以内，29例发生在原发脑损伤手术减压后。40例迟发硬膜外血肿行手术清除，5例保守治疗，死亡7例，死亡率为15．6％。CT或手术中发现迟发血肿部位伴有颅骨骨折32例(71．1％)，伴有矢状窦或横窦损伤10例(22．2％)，仅4例发现明显硬脑膜动脉破裂出血(8．89％)，迟发血肿发生前甘露醇用量达到或超过500ml30例(66．7％)。Logistic回归单因素分析发现患入院时GCS评分和迟发血肿持续时间对迟发硬膜外血肿的预后判别起显性作用。结论：颅骨骨折和／或颅内静脉窦损伤是外伤性迟发硬膜外血肿发生的临床病理基础，原发脑损伤减压手术和甘露醇强力脱水治疗是其发生的促进因素。外伤性迟发硬膜外血肿的预后与患入院时GCS评分和血肿持续时间密切相关。

The clinical mechanism and prognosis of delayed onset of traumatic extradural hematoma

Objective:To explore the clinical mechanism and prognosis of delayed onset of traumatic extradural hematoma(DEDH).Methods:The clinical data of 45 patients with DEDH which defined by computed tomography(CT) and clinical observation were analyzed prospectively.Results:41 cases DEDH occurs within 72 hours after head injury and 29 cases were found after primary head injury surgical decompression.40 cases DEDH were evacuated and 5 cases were reabsorbed spontaneously,7 patients died,mortality was 15.6%(7/45).After operation,32 cases (71.1%) DEDH were found Skull fracture and 10 cases (22.2%) damage to agittal sinus and transverse sinus in the site of hematoma,only 4 cases were identified meningeal arterial bleed.The patients who used mannital were observated in 30 cases before DEDH occurred.The significant factors to predict prognosis of DEDH were Glasgow Coma Scale (GCS) in admission and the time of DEDH last by logistic regression analysis.Conclusion:Skull fracture and/or damage to brain sinus were the basis of clinical pathology of DEDH development.Primary head injury surgical decompression and hydration therapy were the acceleration factors of DEDH occurred.Prognosis of DEDH was significant involved in GCS in admission and the time of DEDH last.