23岁以下创伤性硬膜外血肿临床特点研究  

Investigation on Clinical Characteristics of Traumatic Epidural Hematoma in Less than 23 Years Old Patients

作　　者：田万管[1] 张文涛[1] 朱志宏[1] 黎檀实[1] 

机构地区：[1]中国人民解放军总医院急诊科,北京市100853

出　　处：《中国全科医学》2013年第6期686-688,共3页Chinese General Practice

摘　　要：目的分析23岁以下创伤性硬膜外血肿(EDH)患者的临床特点。方法收集2005年1月—2011年12月我院急诊科、住院病案管理系统记录资料中196例0～23岁EDH患者的临床资料,根据年龄将患者分为3组:婴幼儿及儿童组(0～11岁)49例、青少年组(12～17岁)40例、青年组(18～23岁)107例,回顾性分析各组的性别构成、致伤原因、受伤地点、致伤严重程度〔格拉斯哥昏迷评分(GCS)及损伤严重度评分(ISS)〕、不同类型EDH和颅骨骨折的发生情况以及手术治疗和预后情况。结果 (1)3组患者性别构成、致伤原因及受伤地点比较,差异均有统计学意义(P<0.01);GCS及ISS比较,差异均无统计学意义(P>0.05)。(2)196例EDH患者中小EDH85例(43.4%),大EDH 61例(31.1%),EDH+其他颅内损伤41例(20.9%),EDH但无其他详细信息6例(3.1%),双侧EDH 3例(1.5%);3组患者EDH类型构成比较,差异无统计学意义(P>0.05)。(3)196例EDH患者中发生颅骨骨折145例(74.0%),其中颅盖骨折86例(59.3%),颅底骨折40例(27.6%),颅盖+颅底骨折19例(13.1%);无颅骨骨折51例(26.0%)。3组患者颅骨骨折情况比较,差异有统计学意义(P<0.01)。(4)196例EDH患者中62例(31.6%)进行手术治疗,其中婴幼儿及儿童组14例(28.6%),青少年组12例(30.0%),青年组36例(33.6%),3组手术率比较,差异无统计学意义(χ2=0.462,P=0.794)。(5)196例患者中有9例(4.6%)死亡,其中婴幼儿及儿童组死亡3例(6.1%),青少年组死亡2例(5.0%),青年组死亡4例(3.7%),3组病死率比较,差异无统计学意义(χ2=0.455,P=0.796)。结论婴幼儿及儿童组最常见的损伤原因为坠落伤,损伤地点为家中;青少年组和青年组最常见的损伤原因为交通伤,损伤地点为街道,暴力伤主要出现在青年组。应针对这部分人群开展安全和法制教育,预防EDH的发生。Objective To investigate the clinical characteristics of traumatic epidural hematoma （EDH） in young pa- tients under 23 years. Methods 196 EDH patients from 0 to 23 years old admitted to our hospital from January 2005 to December 2011 were divided into three groups by age： infants and children group （0 to 11 years old） 49 cases, teenagers group （ 12 to 17 years old） 40 cases and youth group （18 to 23 years old） 107 cases. Sex composition, injury causes, injury sites, injury se- verity （GCS and ISS） , different types of EDH, fracture of skull, operation and prognosis of the 196 patients were retrospective- ly analyzed. Results （ 1 ） Sex composition, injury causes and injury sites between the three groups showed statistically signifi- cant differences （P 〈0.01 ）, but GCS and ISS showed no statistically significant difference （P 〉 0.05 ） . （2） Among the 196 cases, 85 of them were small EDH （43.4%）, 61 of them were large EDH （31.1%）, 41 of them were EDH combined with other intracranial injuries （20. 9% ） , 6 of them were without further information （3.1%） and 3 of them were bilateral EDH （ 1.5% ） . The composition of EDH types between the three groups showed no statistically significant difference （ P 〉 0. 05 ） . （3） Among the 196 cases, 145 cases （74. 0% ） had skull fracture, 86 cases （59.3%） had fracture of skull vault, 40 cases （27.6%） had fracture of skull base, 19 cases （ 13.1% ） had fractures of skull vault and skull base and 51 cases （26.0%） had no skull fracture. The difference of skull fractures between the three groups was statistically significant （ P 〈 0. 01 ） . （4） Among the 196 cases, 62 cases （31.6%） were given operation treatment, 14 （28.6%） of which were in infants and children group, 12 （30.0%） of which were in teenagers group and 36 （33.6%） of which were in youths group. The difference of operation rate between the three groups was not statistically significant （χ2 = 0. 462, P =

关 键 词：血肿 硬膜外 颅内 创伤和损伤 颅骨骨折 

分 类 号：R651.154[医药卫生—外科学]