Decompressive Hemicraniectomy for Stroke in Older Adults: A Review.
Decompressive Hemicraniectomy for Stroke in Older Adults: A Review.
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DOI：
10.29245/2572.942x/2017/2.942x/2017/1.1103
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发表时间：
2017-01-01
期刊：
影响因子：
--
通讯作者：
Gormley, William B
中科院分区：
文献类型：
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作者：
Robertson, Faith C;Dasenbrock, Hormuzdiyar H;Gormley, William B
恶性脑水肿是大面积脑梗死的潜在后果，因为由此导致的颅内压升高可能进展为小脑幕切迹疝、脑干压迫和死亡。在适当的患者中，减压性半颅骨切除术（DHC）可降低死亡率，而不会增加严重残疾的风险。然而，由于基础DHC随机对照试验排除了60岁以上的患者，DHC在老年人中的适用性仍然存在争议。最近在老年参与者中进行的临床试验，包括DESTINY II，报告说DHC降低了死亡率，但可能使患者出现严重的发病率。全国范围的分析表明，这些数据具有普遍性。然而，什么是可接受的结局--对严重残疾生存后生活质量的看法--在临床医生、患者和护理人员之间各不相同。因此，生活质量的措施正在越来越多地纳入中风研究。这篇综述总结了DHC在占位性脑梗死中的作用，以及患者年龄对术后生存率、功能能力和生活质量的影响，这些都是临床决策过程中的关键因素。最终，这些数据强调了在老年人中进行半颅骨切除术时，在平衡科学证据、临床专业知识以及患者和家庭偏好方面的固有复杂性。
Malignant cerebral edema is a potential consequence of large territory cerebral infarction, as the resultant elevation in intracranial pressure may progress to transtentorial herniation, brainstem compression, and death. In appropriate patients, decompressive hemicraniectomy (DHC) reduces mortality without increasing the risk of severe disability. However, as the foundational DHC randomized, controlled trials excluded patients greater than 60 years of age, the appropriateness of DHC in older adults remains controversial. Recent clinical trials among elderly participants, including DESTINY II, reported that DHC reduces mortality, but may leave patients with substantial morbidity. Nationwide analyses have demonstrated generalizability of such data. However, what constitutes an acceptable outcome - the perspective on quality of life after survival with substantial disability - varies between clinicians, patients, and caregivers. Consequently, quality of life measures are being increasingly incorporated into stroke research. This review summarizes the impact of DHC in space-occupying cerebral infarction, and the influence of patient age on postoperative survival, functional capacity, and quality of life-all key factors in the clinical decision process. Ultimately, these data underscore the inherent complexity in balancing scientific evidence, clinical expertise, and patient and family preference when pursuing hemicraniectomy among the elderly.