Role of decompressive surgery in the management of severe head injuries: Prognostic factors and patient selection
Role of decompressive surgery in the management of severe head injuries: Prognostic factors and patient selection
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DOI：
10.1089/neu.2005.22.1311
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发表时间：
2005-11-01
影响因子：
4.2
通讯作者：
Tuncer, R
中科院分区：
文献类型：
--
作者：
Ucar, T;Akyuz, M;Tuncer, R
当颅内压（ICP）不能用保守方法治疗时，减压手术或颅骨切除术（DC）是一种治疗选择。本研究的目的是评价去骨瓣减压术治疗难治性外伤后颅内血肿的疗效。高血压，并评估本管理方案的患者选择标准。在这项研究中，100例严重头部损伤患者参与。所有患者均根据欧洲脑损伤联盟（EBIC）严重头部损伤指南进行治疗，并根据个人初始格拉斯哥昏迷评分（GCS）、年龄、格拉斯哥结局评分（GOS）、全身损伤的存在、ICP变化、肿块病变的存在和DC的正确时机进行评估。所有患者的GCS均为8或更低。根据患者的初始GCS，将患者分为两组，每组60例（GCS 4-5分的I组）和40例（GCS 6-8分的II组）。根据GOS评分评价预后。DC治疗后，84例患者（84%）表现出不良结局，16例（16%）表现出良好结局。在第1组中，58例患者（96.6%）显示不利结局，2例（3.4%）显示有利结局。在第11组中，26例（65%）患者显示不利结局，14例（25%）显示有利结局。初始GCS和年龄对患者结局的重要性具有统计学意义。全身损伤或肿块病变的存在在结局中没有统计学意义。根据我们的研究结果，我们得出结论，格拉斯哥昏迷评分为6-8的患者是DC治疗的最佳候选人。
Decompress(ve surgery or craniectomy (DC) is a treatment option, which should be considered when the intracranial pressure (ICP) cannot be treated by conservative methods. The purpose of this study was to evaluate the benefits of decompressive craniectomy in patients with intractable posttraumatic intracranial. hypertension and to evaluate the patient selection criteria for this management protocol. In this study, 100 patients with severe head injuries were involved. All patients were treated according to the European Brain Injury Consortium (EBIC) guidelines for severe head injuries and were assessed based on individual initial Glasgow Coma Scores (GCS), age, Glasgow Outcome Score (GOS), presence of systemic injury, changes in ICP, presence of mass lesion and the right timing for DC. All patients presented with a GCS of 8 or below. Based on their initial GCS, the patients were divided in two groups of 60 (group I with GCS 4-5) and 40 (group II with GCS 6-8) in each, respectively. Prognosis was evaluated according to the (GOS). After treatment with DC, 84 of the patients (84%) showed unfavorable and 16 (16%) showed favorable outcomes. In group 1, 58 patients (96.6%) showed unfavorable and two (3.4%) showed favorable outcomes. In group 11, 26 (65%) patients showed unfavorable and 14 (25%) showed favorable outcomes. The importance of initial GCS and age in patient outcomes were statistically significant. The presence of systemic injuries or mass lesions in outcomes were not statistically significant. Based on our findings, we conclude that patients with Glasgow Coma Scores of 6-8 are the best candidates for DC treatment.