Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation: A propensity matched study
Decompressive craniectomy versus craniotomy only for intracranial hemorrhage evacuation: A propensity matched study
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DOI：
10.1097/ta.0000000000001658
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发表时间：
2017-12-01
影响因子：
3.4
通讯作者：
Joseph, Bellal
中科院分区：
文献类型：
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作者：
Jehan, Faisal;Azim, Asad;Joseph, Bellal
背景颅骨减压术(DC)常与颅内出血(ICH)清除术同时进行，以控制创伤性脑损伤(TBI)患者的颅内压(ICP)。DC在降低颅内压方面的有效性是公认的；然而，它对临床结果的影响仍然存在争议。我们研究的目的是评估接受DC和单纯开颅(CO)的脑出血患者的预后。方法我们对因创伤性脑出血而行开颅手术或开颅手术的脑出血患者进行了5年的回顾性分析。患者被分成两组，分别接受CO和DC。倾向评分与患者在人口统计学、入院格拉斯哥昏迷评分(GCS)、损伤严重程度、脑出血类型和大小以及抗凝剂使用方面的比例为1：2。观察指标包括死亡率、不良出院倾向(熟练的护理设施)、出院GCS和格拉斯哥预后量表评分和并发症。结果我们回顾了1831例脑外伤患者，其中155例接受了开颅手术和/或开颅手术。在倾向评分匹配后，我们将99名患者纳入我们的研究(DC，33例；CO，66例)。匹配组在年龄(p=0.68)、入院GCS评分(p=0.50)、损伤严重程度评分(p=0.70)、头部缩略伤量表评分(p=0.32)和颅内出血特征方面相似。总体而言，26.3%(n=26)的患者死亡，62.6%(n=62)的患者被送往康复/熟练护理机构。DC组和CO组在出院时死亡率(27.3%比25.0%；p=0.99)、不良出院倾向(45%比33%；p=0.66)、GCS评分(p=0.53)和格拉斯哥预后评分(p=0.80)方面没有差异。然而，DC组患者的并发症发生率和呼吸机使用天数较高。结论本研究显示，无论采用何种手术方式，接受脑出血清除术的患者的临床结局均无显著差异。DC似乎并不优于单纯开颅手术治疗急性脑出血。证据治疗水平，III级。
BACKGROUND Decompressive craniectomy (DC) is often performed in conjunction with evacuation of intracranial hemorrhage (ICH) to control intracranial pressure (ICP) in patients with a traumatic brain injury (TBI). The efficacy of DC in lowering ICP is well established; however, its effect on clinical outcomes remains controversial. The aim of our study is to assess outcomes in TBI patients undergoing DC versus craniotomy only (CO) for the evacuation of ICH.METHODS We performed a 5-year retrospective analysis of TBI patients with ICH who underwent craniotomy or craniectomy for traumatic ICH. Patients were divided into two groups, those who underwent CO and those who underwent DC. Propensity scoring matched patients in a 1:2 ratio for demographics, admission Glasgow Coma Scale (GCS) score, severity of injury, type and size of ICH, and anticoagulant use. Outcome measures included mortality, adverse discharge disposition (skilled nursing facility), discharge GCS and Glasgow Outcome Scale scores, and complications.RESULTS We reviewed 1,831 patients with TBI, of which 155 underwent craniotomy and/or craniectomy. After propensity score matching, we included 99 of those patients in our study (DC, 33; CO, 66). Matched groups were similar in age (p = 0.68), admission GCS score (p = 0.50), Injury Severity Score (p = 0.70), head Abbreviated Injury Scale score (p = 0.32), and intracranial bleeding characteristics. Overall, 26.3% (n = 26) of the patients died and 62.6% (n = 62) were discharged to Rehab/skilled nursing facility. There was no difference in the mortality rate (27.3% vs. 25.0%; p = 0.99), adverse discharge disposition (45% vs. 33%; p = 0.66), GCS score (p = 0.53), and Glasgow Outcome Scale (p = 0.80) at discharge between the DC and the CO groups. However, patients in DC group had higher complication rates and ventilator days.CONCLUSION This study showed no significant difference in clinical outcomes for patients undergoing evacuation of ICH regardless of the procedure performed. DC did not appear to be superior to craniotomy alone for the treatment of acute ICH.LEVEL OF EVIDENCE Therapeutic, level III.