Decompressive craniectomy in pediatric patients with traumatic brain injury with intractable elevated intracranial pressure
Decompressive craniectomy in pediatric patients with traumatic brain injury with intractable elevated intracranial pressure
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DOI：
10.1016/j.jpedsurg.2005.10.010
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发表时间：
2006-01-01
影响因子：
2.4
通讯作者：
Lee, TK
中科院分区：
文献类型：
--
作者：
Rutigliano, D;Egnor, MR;Lee, TK
背景资料：儿科创伤性脑损伤（TBI）的护理重点是最大限度地提高脑灌注，以防止缺血和再灌注损伤。尽管进行了积极的治疗，包括脑室造口术、戊巴比妥昏迷、高渗盐水和利尿剂，但一部分TBI患者仍将继续出现难治性颅内压（ICP）升高。去骨瓣减压术（DC）是一种有争议的治疗严重TBI。这是我们的假设，DC可以提高生存率，并尽量减少继发性脑损伤，在此患者subset.Methods：患者年龄小于20岁，在一级区域创伤中心2001年11月和2004年11月之间，谁符合纳入标准的脑创伤基金会TBI-trac临床数据库。将所有具有与TBI一致的损伤机制且复苏后至少6小时格拉斯哥昏迷量表评分小于9且在急诊室未死亡的患者输入临床数据库。受伤后超过24小时到达研究医院的患者被排除在外。就诊时平均格拉斯哥昏迷量表评分为8分，范围为3 - 13分。6例患者因顽固性ICP升高接受DC。6例术后颅内压（ICP）<20 mm Hg者5例。1例患者需要返回手术室，在那里进行进一步的脑清创术。所有接受DC的患者均存活下来，并出院到TBI康复facility.Conclusion：虽然这是一个小样本，DC应考虑在TBI患者难治性ICP升高。对这一患者人群的长期随访应包括神经精神评估和社会功能测量。(c)2006年爱思唯尔公司All rights reserved.
Background: Care of pediatric traumatic brain injury (TBI) has placed emphasis on maximizing cerebral perfusion to prevent ischemia and reperfusion injury. A subset of patients with TBI will continue to have refractory intracranial pressure (ICP) elevation despite aggressive therapy including ventriculostomy, pentobarbital coma, hypertonic saline, and diuretics. Decompressive craniectomy (DC) is a controversial treatment of severe TBI. It is our hypothesis that DC can enhance survival and minimize secondary brain injury in this patient subset.Methods: Patients younger than 20 years treated at a level I regional trauma center between November 2001 and November 2004, who met inclusion criteria for the Brain Trauma Foundation TBI-trac clinical database were included. All patients with a mechanism of injury consistent with TBI and Glasgow Coma Scale score of less than 9 for at least 6 hours after resuscitation and who did not die in the emergency department are entered into a clinical database. Patients who arrived at the study hospital more than 24 hours after injury are excluded.Results: There were 30 patients with TBI identified. The mean Glasgow Coma Scale score at presentation was 8 with a range of 3 to 13. Six patients underwent DC for intractable elevated ICP. Of 6 patient's postoperative ICP, 5 were less than 20 mm Hg. One patient required a return to the operating room where further debridement of brain was performed. All patients who received a DC survived and were discharged to a TBI rehabilitation facility.Conclusion: Although this is a small sample, DC should be considered in patients with TBI with refractory elevated ICP. Long-term follow-up of this patient population should consist of neuropsychiatric evaluation in conjunction with measurement of social function. (c) 2006 Elsevier Inc. All rights reserved.