72例外伤性迟发性颅内血肿临床分析

Clinical Profiles in 72 Cases of Delayed Traumatic Intracranial Hematoma

目的：探讨外伤性迟发性颅内血肿（DTIH）的临床表现及转归,为其临床诊断治疗提供依据。方法：回顾性分析本院2005年1月-2008年10月收治922例颅脑外伤中,72例DTIH病例的临床表现及头颅CT扫描变化,并观察治疗后转归。结果：72例DTIH中,颅脑外伤后6-24 h内出现者42例（58.3%）;25-72 h内有21例（29.2%）,3-7 d有8例（11.1%）,9 d有1例（1.4%）;术后恢复良好41例（56.9%）,轻度伤残8例（11.1%）,中度伤残5例（6.94%）,重度伤残4例（5.6%）,植物生存2例（2.8%）,死亡12例（16.7%）;血肿位于额部37例（51.4%）,颞部26例（36.1%）,顶枕部9例（12.5%）。结论：DTIH多发生于患者伤后1周以内,它是颅脑外伤后颅内血肿的重要类型,对其进行早期诊断是及时治疗、降低DTIH致残率和致死率的关键。

Objective：To investigate the clinical manifestations and outcomes of delayed traumatic intraeranial hematoma （DTIH） , and to provide evidence for diagnosis and treatment of this condition. Methods： Retrospective analysis of clinical manifestations and changes in CT imaging was performed in 72 DTIH patients among 922 cases of craniocerebral trauma. Outcomes of treatment were also recorded. Results： Among these 72 patients, 42 （58.3%） developed DTIH between hours 6 and 24 after brain trauma, 21 （29.2%） between hours 25 and 72, 8 （ 11. 1% ） between days 3 and 7, and one （ 1.4% ） on day 9. After surgery, favorable recovery was achieved in 41 cases （ 56.9% ） , whereas mild disability was recorded in 8 cases （ 11. 1% ） , moderate disability in 5 cases （ 6.94% ） and severe disability in 4 cases（5.6% ）, persistent vegetative state in 2 cases（2.8% ）and death in 12 cases（ 16.7% ）. Hematoma was localized at the frontal region in 37 eases（51.4% ） , temporal region in 26 （36.1% ）, occipito-parietal region in 9 cases（ 12.5% ）. Conclusion： DTIH as a major type of intracranial hematoma after cranioeerebral trauma was found to develop frequently within one week. Early diagnosis and prompt treatment should be the key to reduce disability and death.