儿童创伤性迟发性硬膜外血肿12例临床特征分析

目的分析12例创伤性迟发性硬膜外血肿(DTEDH)患儿的临床特征,以期提高临床对儿童DTEDH的认识。方法选取河南科技大学第一附属医院2014年4月—2018年4月收治的DTEDH患儿12例,回顾性分析其临床特征,包括临床表现、影像学特征、治疗方法及预后等。结果(1)临床表现:头痛7例,呕吐6例,不同程度意识障碍4例,单侧肢体肌力下降4例,脑脊液漏2例,癫痫1例。(2)影像学特征:12例患儿入院后首次颅脑CT检查均未发现硬膜外血肿表现,发现颅骨骨折伴颅内积气6例,局部脑挫裂伤2例,蛛网膜下腔出血1例;常规复查颅脑CT确诊DTEDH 5例,因症状加重急查颅脑CT确诊DTEDH 7例,CT表现为梭形高密度影。(3)治疗方法:3例患儿血肿量分别为10、10、15 ml,采用药物保守治疗;5例患儿血肿量为25~30 ml,行微创穿刺引流术治疗;4例患儿血肿量为30~50 ml,行开颅血肿清除+去骨瓣减压术治疗。1例患儿由于合并严重贫血而进行输血治疗。(4)预后:11例好转出院,1例因开颅血肿清除+去骨瓣减压术后并发肺部感染而死亡;11例好转出院患儿随访3~6个月均未遗留明显后遗症。结论儿童DTEDH起病较隐匿,致死率、致残率较高,对于高度怀疑DTEDH的患儿,临床医师应提高警惕并注意动态复查颅脑CT,以早期明确诊断,合理选择治疗方法以改善患儿预后。

Clinical Features of Twelve Children with Delayed Traumatic Epidural Hematoma

Objective To analyze the clinical features of twelve children with delayed traumatic epidural hematoma(DTEDH).Methods A total of twelve children with DTEDH were selected in the First Affiliated Hospital of Henan University of Science and Technology form April 2014 to April 2018,their clinical features were retrospectively analyzed,mainly including clinical manifestations,imaging characteristics,therapeutic methods and prognosis.Results(1)Clinical manifestations:7 cases performed as headache,6 cases as emesis,4 cases as varying degrees of disturbance of consciousness,4 cases as unilateral limb decrease of myodynamia,2 cases as leakage of cerebrospinal fluid,1 case as epilepsy.(2)Imaging characteristics:the first craniocerebral CT scanning results of the twelve children did not show epidural hematoma,but found 6 cases complicated with skull fracture and intracranial pneumatosis,2 cases with local cerebral contusion and laceration,1 case with subarachnoid hemorrhage;5 cases confirmed as DTEDH after routine craniocerebral CT reexamination,7 cases received emergency CT examination due to exacerbation of symptoms and then confirmed as DTEDH,the CT examination results showed fusiform high density shadow.(3)Therapeutic methods:3 cases(hematoma volume was 10 ml,10 ml and 15 ml,respectively)received conservative medical treatment;5 cases with hematoma volume ranged from 25 to 30 ml received minimally invasive puncture and drainage;4 cases with hematoma volume ranged from 30 to 50 ml received craniotomy for hematoma clearance and decompressive craniectomy.Besides,1 case received blood transfusion due to severe anemia.(4)Prognosis:11 cases improved and discharged,1 case died due to pulmonary infection after craniotomy for hematoma clearance and decompressive craniectomy;11 cases discharged with improvement did not left any obvious sequelae during the 3-to 6-month follow-up.Conclusion Onset of DTEDH is relatively concealed,but its lethality rate and disability rate are relatively high,thus clinicians should be on the alert and pay attention to dynamic craniocerebral CT reexamination when find children highly suspected as DTEDH,to make a early definite diagnosis and reasonable choice of treatment to eventually improve the prognosis.