| 摘要 |
An unselected, consecutive series of 162 patients with epidural hematoma (EDH), treated in this clinic between Angust 1981 and May 1993, is reviewed. The overall mortality was 11.1 %, with 1.9% having severe disability or remaining in a vegetative state. Among the 162 cases of EDH, 141 cases received surgical treatment. The surgical mortality was 12%; 86% made a functional recovery. There were 51 patients (36.2%) in deep coma before operation, and their mortality was 25.5%. A correlation was found between the final result and preoperative Glasgow coma scale (GCS) score or motor score and preoperative pupil sign, the size of the hematoma and associated intracranial lesions. Among these, the motor score immediatly before operation was the most important preoperative predictor of outcome. The mortality rate was higher in patients operated on within 5 hours (13.6% mortality) and from 5 to 12 hours (11.8% mortality) of arrival than in those undergoing surgery 12 or more hours after arrival (4.8% mortality). Compared with the patients operated on later, the patients undergoing surgery in the early period had, on the average, lower motor scores, more pupillary changes, a larger volume of hematoma and more midline shifting. In those patients, it is possible that a rapidly developing EDH contributed to a higher mortality. For total cases of EDH who had received craniotomy, 18.4% had one or more associated intracranial lesions and their mortality was 19.2%. Hence associated intracranial lesions may adversly affect the final outcome. The existence of associated intracranial lesions may also decrease the tolerance of the brain to the presence of EDH and necessitate early operation or operation for small EDH. Patients with small EDH (below 20 ml in size) and without associated intracranial lesion, plus clear or steadily improving conscious level may be treated conservatively. |
