Decompressive craniectomy for severe traumatic brain injury:: Evaluation of the effects at one year
Decompressive craniectomy for severe traumatic brain injury:: Evaluation of the effects at one year
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DOI：
10.1097/01.ccm.0000089927.67396.f3
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发表时间：
2003-10-01
影响因子：
8.8
通讯作者：
Martin, C
中科院分区：
文献类型：
--
作者：
Albanèse, J;Leone, M;Martin, C
目的：评估在严重颅脑损伤合并顽固性脑高血压患者中，在创伤后 24 小时内或之后进行去骨瓣减压术对结果（1 年）的影响。设计：回顾性队列研究。设置：大学医院的重症监护室。患者。 816例严重头部外伤（格拉斯哥昏迷评分小于或等于8级）患者中，40例接受了去骨瓣减压术。数据收集后，患者被分为两组：早期去骨瓣减压术和晚期去骨瓣减压术。根据以下标准，在最初 24 小时内对患者进行早期去骨瓣减压术：根据以下标准进行格拉斯哥昏迷量表评分（24 小时）：颅内压 >35 mm Hg 的顽固性颅内高压，单侧或双侧瞳孔反射缺失，以及计算机断层扫描扫描中出现与前述相同的异常。 干预：27 例有脑梗塞体征的患者疝气需要在初次清除肿块病变时进行手术。在 13 名患者中，由于颅内压升高而难以接受包括脑脊液引流、深度镇静、渗透疗法、过度通气以及奈斯多那或异丙酚在内的药物治疗，因此进行了去骨瓣减压术。 测量和主要结果：早期进行去骨瓣减压术的 5 名患者 (19%) 恢复良好（社会康复），8 名患者 (30%) 仍处于持续状态植物人或严重残疾，死亡 14 人（52%）。另一方面，在药物治疗失败的情况下进行晚期去骨瓣减压术后，5 名患者（38%）进行了社会康复，3 名患者（23%）死亡。 5 名患者 (38%) 出现持续植物人状态或严重残疾。去骨瓣减压术后有6例患者出现脑膜炎或脑脓肿，经抗生素治疗后易治愈。结论。在 40 名患有顽固性颅内高压且脑死亡风险极高的患者中，去骨瓣减压术使 25% 的患者在 1 年内实现了社会康复。
Objective: To assess the effect on outcome (1 yr) of decompressive craniectomy performed within or after the first 24 hrs posttrauma in severely head-injured trauma patients with intractable cerebral hypertension.Design: Retrospective cohort study.Settings: Intensive care unit of a university hospital.Patients. Among 816 patients with severe head trauma (Glasgow Coma Scale less than or equal to8), 40 underwent decompressive craniectomy. After data collection, patients were divided into two groups: early and late decompressive craniectomy. An early decompressive craniectomy was performed within the first 24 hrs in patients according to the following criteria: a Glasgow Coma Scale score 24 hrs) was performed according to following criteria: an intractable intracranial hypertension with intracranial pressure >35 mm Hg, a unilateral or bilateral absence of pupillary reflexes, and the same abnormalities in computed tomography scan as previously described.Intervention: Twenty-seven patients with signs of cerebral herniation required the procedure at the time of initial evacuation of a mass lesion. In 13 patients, decompressive craniectomy was performed because of elevated intracranial pressure refractory to medical treatment consisting of cerebrospinal fluid derivation, deep sedation, osmotherapy, hyperventilation, and nesdonal or propofol.Measurements and Main Results: Five patients (19%) in whom an early decompressive craniectomy was performed had good recoveries (social rehabilitation), eight patients (30%) remained in a persistent vegetative state or with a severe disability, and 14 died (52%). On the other hand, the performance of late decompressive craniectomy in case of medical treatment failure was followed by social rehabilitation in five patients (38%) and death in three patients (23%). A persistent vegetative state or a severe disability was observed in five patients (38%). Meningitis or cerebral abscess occurred in six patients after decompressive craniectomy and were easily cured by antibiotic treatment.Conclusions. In 40 patients with intractable intracranial hypertension and at very high risk of brain death, decompressive craniectomy allowed 25% of patients to attain social rehabilitation at 1 yr.