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目的探讨迟发性外伤性硬脑膜外血肿(DEDH)的病因、诊断、治疗方法及效果。方法对78例DEDH患者按照伤后初期头颅CT检查至CT复查明确诊断为止,共划分为5个时间段(<6 h、7～12 h、13～24 h、25～48 h、>49 h),并分别比较术前诊断、术中诊断与术后诊断DEDH的治疗结果。结果6～24 h内明确诊断者共60例,占全组76.9%(60/78);伤后12 h内44例,占全组56.4%(44/78)。术中诊断出迟发性血肿病例的死亡率(37.5%,3/8)高于术前(14.3%,6/42)与术后(21.4%,6/28)诊断出迟发性血肿病例的死亡率,但没有统计学差异。结论DEDH多见于伤后24 h内,特别是在伤后12 h内的病例占全组病例数半数以上(56.4%,44/78)。其发病机理尚未完全明了,但与血管舒缩机制障碍、低血压、低氧血症及开颅减压术后失去“填塞效应”的作用有一定关系。术中发生的DEDH常诊断困难,且死亡率也明显增高。外伤后CT动态检查协助医生能作出及时诊断与处理,也是降低患者死亡率与伤残率的关键。
Objective To investigate the etiology, diagnosis, treatment and effect of delayed traumatic epidural hematoma (DEDH). Methods A total of 78 patients with DEDH were divided into 5 periods (<6 h, 7 ~ 12 h, 13 ~ 24 h, 25 ~ 48 h,> 49 h ), And compared preoperative diagnosis, intraoperative diagnosis and postoperative diagnosis of DEDH treatment results. Results A total of 60 cases were diagnosed in 6 ~ 24 h, accounting for 76.9% (60/78) in the whole group; 44 cases (56.4%, 44/78) in 12 h after injury. Mortality of delayed hematoma cases (37.5%, 3/8) was higher than that of preoperative (14.3%, 6/42) and postoperative (21.4%, 6/28) cases of delayed hematoma The mortality rate, but no statistical difference. Conclusion DEDH is more common in the 24 hours after injury, especially in the 12 hours after injury cases accounted for more than half of the total number of cases (56.4%, 44/78). Its pathogenesis is not yet fully understood, but with vasomotor mechanism disorders, hypotension, hypoxemia and craniotomy decompression after the loss of “stuffing effect” has a certain relationship. Intraoperative DEDH often difficult diagnosis, and mortality was significantly higher. Post-traumatic CT dynamic examination to help doctors make timely diagnosis and treatment, but also reduce the mortality and disability rate of the key.