尚不清楚硬膜下血肿的确切发病率。在因轻度到中度创伤性脑损伤就诊的患者中,有 11%-20% 的患者被发现有急性硬膜下血肿。[3]Servadei F, Nasi MT, Giuliani G, et al. CT prognostic factors in acute subdural haematomas: the value of the 'worst' CT scan. Br J Neurosurg. 2000 Apr;14(2):110-6.http://www.ncbi.nlm.nih.gov/pubmed/10889882?tool=bestpractice.com 在美国,因闭合性颅脑损伤而住院的年发生率估计为 200/100,000。[4]Narayan RK, Michel ME, Ansell B, et al. Clinical trials in head injury. J Neurotrauma. 2002 May;19(5):503-57.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1462953/http://www.ncbi.nlm.nih.gov/pubmed/12042091?tool=bestpractice.com 总的来说,硬膜下血肿占急性创伤性颅内血肿的50%~60%,因摔倒或斗殴后较车祸外伤更易导致硬膜下血肿。[1]Zwienenberg-Lee M, Muizelaar JP. Clinical pathophysiology of traumatic brain injury. In: Winn HR, Youmans JR (eds): Youmans Neurological Surgery. Philadelphia, PA: WB Saunders; 2004:5039-64.[5]Fisher B, Thomas D, Peterson B. Hypertonic saline lowers raised intracranial pressure in children after head trauma. J Neurosurg Anesthesiol. 1992 Jan;4(1):4-10.http://www.ncbi.nlm.nih.gov/pubmed/15815431?tool=bestpractice.com[6]Marshall L, Gautille T, Klauber M. The outcome of severe closed head injury. J Neurosurg. 1991;75:S28-36. 合并凝血功能异常(医源性或病理性)的患者,硬膜下血肿的发病率升高。[1]Zwienenberg-Lee M, Muizelaar JP. Clinical pathophysiology of traumatic brain injury. In: Winn HR, Youmans JR (eds): Youmans Neurological Surgery. Philadelphia, PA: WB Saunders; 2004:5039-64.[7]Kawamata T, Takeshita M, Kubo O, et al. Management of intracranial hemorrhage associated with anticoagulant therapy. Surg Neurol. 1995 Nov;44(5):438-42;discussion 443.http://www.ncbi.nlm.nih.gov/pubmed/8629228?tool=bestpractice.com[8]Wintzen AR, de Jonge H, Loeliger EA, et al. The risk of intracerebral hemorrhage during oral anticoagulant treatment: a population study. Ann Neurol. 1984 Nov;16(5):553-8.http://www.ncbi.nlm.nih.gov/pubmed/6508238?tool=bestpractice.com 使用维生素 K 拮抗剂时患硬膜下血肿的风险约为使用凝血因子 Xa 或抗血小板剂时的 3 倍,约为使用直接凝血酶抑制剂时的 2 倍。[9]Connolly BJ, Pearce LA, Hart RG. Vitamin K antagonists and risk of subdural hematoma: meta-analysis of randomized clinical trials. Stroke. 2014 Jun;45(6):1672-8.http://stroke.ahajournals.org/content/45/6/1672.longhttp://www.ncbi.nlm.nih.gov/pubmed/24876259?tool=bestpractice.com
据估计,在美国,慢性硬膜下血肿的总体年发病率为 20/100,000。[10]Karibe H, Kameyama M, Kawase M, et al. Epidemiology of chronic subdural hematomas [in Japanese]. No Shinkei Geka. 2011 Dec;39(12):1149-53.http://www.ncbi.nlm.nih.gov/pubmed/22128269?tool=bestpractice.com 慢性硬膜下血肿更常见于大于65岁的老年人中,并通常与摔倒史或抗凝药物使用史相关。[11]Baechli H, Nordmann A, Bucher HC, et al. Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev. 2004 Oct;27(4):263-6.http://www.ncbi.nlm.nih.gov/pubmed/15148652?tool=bestpractice.com