作者：亢崇仰1，2 ，陆兆丰 2 ，陈悦华 1，2

单位：

1.471003 河南省洛阳市，河南科技大学临床医学院　；2.471003 河南省洛阳市，河南科技大学第一附属医院；通信作者：陆兆丰，E-mail：352751591@qq.com

Units：

1.College of Clinical Medicine，Henan University of Science and Technology，Luoyang 471003，China；2.The First Affiliated Hospital of Henan University of Science and Technology，Luoyang 471003，China；Corresponding author：LU Zhaofeng，E-mail：352751591@qq.com

关键词：

血肿，硬膜外，颅内；颅脑损伤；创伤和损伤；儿童；疾病特征

Keywords：

Hematoma，epidural，cranial；Craniocerebral trauma；Wounds and injuries；Child；Diseaseattributes

CLC：

R 651.15

DOI：

DOI：10.3969/j.issn.1008-5971.2020.02.014

Funds：

摘要：

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。

Abstract：

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 Universityof Science and Technology form April 2014 to April 2018，their clinical features were retrospectively analyzed，mainly includingclinical 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 casesas unilateral limb decrease of myodynamia，2 cases as leakage of cerebrospinal fluid，1 case as epilepsy.（2）Imagingcharacteristics：the first craniocerebral CT scanning results of the twelve children did not show epidural hematoma，but found6 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 casesreceived emergency CT examination due to exacerbation of symptoms and then confirmed as DTEDH，the CT examinationresults showed fusiform high density shadow.（3）Therapeutic methods：3 cases（hematoma volume was 10 ml，10 ml and 15ml，respectively）received conservative medical treatment；5 cases with hematoma volume ranged from 25 to 30 ml receivedminimally invasive puncture and drainage；4 cases with hematoma volume ranged from 30 to 50 ml received craniotomy forhematoma 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 clearanceand decompressive craniectomy；11 cases discharged with improvement did not left any obvious sequelae during the 3- to6-month follow-up. Conclusion　Onset of DTEDH is relatively concealed，but its lethality rate and disability rate are relativelyhigh，thus clinicians should be on the alert and pay attention to dynamic craniocerebral CT reexamination when find children highlysuspected as DTEDH，to make a early definite diagnosis and reasonable choice of treatment to eventually improve the prognosis.

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