Decompressive craniectomy in patients with uncontrollable intracranial hypertension.
Decompressive craniectomy in patients with uncontrollable intracranial hypertension.
复制标题
无法控制的颅内高压患者的去骨瓣减压术。
DOI：
10.1007/978-3-7091-6475-4_5
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
K. Roosen
中科院分区：
文献类型：
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作者：
Ekkehard Kunze;J. Meixensberger;M. Janka;N. Sörensen;K. Roosen
对于重型颅脑损伤后颅内压升高患者行颅内压减压切除术的益处，一直存在争议。本回顾性研究的目的是分析在最大限度的积极药物治疗后，无法控制的ICP升高患者进行二次减压颅骨切除术的结果。回顾性分析28例重型颅脑损伤合并创伤后脑水肿患者（平均年龄22岁，年龄范围8 ~ 44岁）的资料。原发病灶大、缺氧、缺血性梗死、脑干损伤和中枢性疝的患者不需要手术。一年后根据格拉斯哥结果量表（GOS）对结果进行分类。术后平均68小时行减压颅内压（ICP < 25 mm Hg）持续下降，脑灌注压（CPP > 75 mm Hg）改善，脑血流及微循环恢复正常。术后1年预后良好15例（56%），严重残疾5例（18%），植物人4例（14%），死亡3例（11%）。尤其是年轻的颅脑损伤和颅内压升高患者，保守治疗方法无法控制，应牢记将减压术作为治疗的最后一步。
There has been controversial discussion about the benefits of decompressive craniectomy in patients with critically raised intracranial pressure (ICP) after severe head injury. The aim of this retrospective study was to analyze the results of secondary decompressive craniectomy in patients with uncontrollable raised ICP after maximum aggressive medical treatment. The data of 28 patients (mean age 22 years, range 8-44 years) with severe head injury and posttraumatic cerebral edema were analyzed retrospectively. Surgery was not indicated in patients with vast primary lesions, hypoxia, ischemic infarction, brainstem injuries and central herniation. The outcome was classified according to the Glascow Outcome Scale (GOS) after one year. The decompressive crainectomy was performed an average of 68 hours after trauma, and ICP (< 25 mm Hg) decreased always while cerebral perfusion pressure (CPP > 75 mm Hg) improved as well as cerebral blood flow and microcirculation to normal values. 15 patients (56%) had a good outcome after one year (GOS 4 + 5). 5 patients (18%) were severely disabled, 4 patients (14%) remained in vegetative state and 3 patients (11%) died. Decompressive craniectomy should be kept in mind as the last therapeutic step, especially in young patients with head injury and raised ICP, which is not controllable with conservative methods.