儿童轻中症外伤性硬膜外血肿临床症状进展的风险因素分析  

Analysis of risk factors for progressive clinical symptoms in children with mild-and-moderate traumatic epidural hematoma

作　　者：张毅 施伟 郑继翠 赵瑞 李昊 Zhang Yi;Shi Wei;Zheng Jicui;Zhao Rui;Li Hao(Department of Neurological Surgery,Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院神经外科,上海201102

出　　处：《中华小儿外科杂志》2021年第10期878-882,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的分析与儿童轻中症外伤性硬膜外血肿临床症状进展相关的风险因素。方法收集2013年1月至2017年12月因外伤致"硬膜外血肿"收入或转入复旦大学附属儿科医院的患儿共203例,不合并硬膜下出血、蛛网膜下腔出血、脑实质出血及脑挫裂伤。按照本研究患儿的排除标准共纳入168例患儿。其中,男79例,女89例;患儿就诊时中位GCS评分为14分,范围为10~15分;中位年龄为3.8岁,范围为0.1~14.3岁;车祸外伤66例[39.3%(66/168)];呕吐为最常见的临床表现,占48.8%(82/168),其中21.4%(36/168)的患儿呕吐次数>2次;绝大多数患儿合并颅骨骨折,占86.9%(146/168);硬膜外血肿常见于颞部,占40.5%(68/168);外伤后血糖升高见于45.8%(77/168)的患儿;有28.6%(48/168)的患儿出现D-二聚体升高。根据入院后诊疗过程中GCS评分的变化,分为临床症状平稳组(104例)和临床症状进展组(64例)。通过对患儿基本信息、外伤因素、临床症状、CT检查结果及检验结果进行单因素、多因素Logistic回归及受试者操作特征(receiver operator characteristic curve,ROC)曲线分析,寻找与轻中症患儿临床症状进展相关的风险因素。结果单因素的分析显示临床症状进展组患儿在外伤后存在意识丧失史的比例较临床症状平稳组高,34.4%(22/64)比15.4%(16/104),差异具有统计学意义(P=0.004)。外伤后血肿的厚度及体积与临床症状进展并无明显相关性。血肿占位效应在临床症状进展组较临床症状平稳组出现临床症状进展的风险较高,53.1%(34/64)比13.5%(14/104),差异具有统计学意义(P<0.01)。颞部血肿在临床症状进展组较临床症状平稳组出现临床症状进展的风险较高,56.3%(36/64)比30.8%(32/104),差异具有统计学意义(P<0.05)。血肿初始CT值偏低的血肿在临床症状进展组较临床症状平稳组出现临床症状进展的风险较高,(48.40±6.77)Hu比(60.70±5.25)Hu,差异具有统计学意义(P<0.05)。临床症状进展Objective To explore the risk factors related to the progression of clinical symptoms of mild-to-moderate traumatic epidural hematoma in children.Methods From January 2013 to December 2017,203 cases of"epidural hematoma"due to trauma were collected,without subdural hemorrhage,subarachnoid hemorrhage,cerebral parenchymal hemorrhage or brain contusion.A total of 168 children were recruited,including 79 boys and 89 girls with a median age of 3.8(0.1-14.3)years and a median GCS score of 14(10-15);there were 66 cases of traffic accident trauma[39.3%(66/168)];vomiting 48.8%(82/168)was the most common clinical manifestation;21.4%(36/168)vomited more than twice;86.9%(146/168)had skull fractures;epidural hematomas were common in temporal region 40.5%(68/168);elevated blood glucose after trauma could be seen in 45.8%(77/168);28.6%(48/168)had elevated D-dimer.According to the change of GCS score(a decline of>2 points)during diagnosis and treatment,they were divided into two groups of stable(n=104)and progression(n=64).Through univariate and multivariate Logistic regression and receiver operator characteristic curve(ROC)curve analysis of basic profiles,traumatic factors,clinical symptoms,CT examination results and blood test results,the risk factors related to the progression of clinical symptoms were examined in children with mild-and-moderate traumatic epidural hematoma.Results The aggravated group was more likely to present with a loss of consciousness[34.4%(22/64)vs 15.4%(16/104),P<0.01],temporal hematoma and mass effect[56.3%(36/64)vs 30.8%(32/104),P<0.05,53.1%(34/64)vs 13.5%(14/104),P<0.01],hematoma initial CT value(48.40±6.77 vs 60.70±5.25,P<0.05),elevated D-dimer level[42.2%(27/64)vs 20.2%(21/104),P<0.01]and higher blood glucose level(8.11±2.75 vs 7.22±1.16,P<0.01)in single factor analysis.Hematoma initial CT value[OR=13.1,95%CI(0.5,1.8),P<0.001]and mass effect[OR=4.37;95%CI(1.1,14.6),P<0.05].Hematoma initial CT value was an excellent predictor of neurological deficits with an area under the ROC curve(AUC)of 0.92

关 键 词：血肿 硬膜外 颅内 颅脑外伤 格拉斯哥评分 CT值 

分 类 号：R726.5[医药卫生—儿科]