Skoglund Thomas S, Eriksson-Ritzén Catherine, Jensen Christer, Rydenhag Bertil
Department of Neurosurgery, Sahlgrenska University Hospital, Göteborg, Sweden.
J Neurotrauma. 2006 Oct;23(10):1502-9. doi: 10.1089/neu.2006.23.1502.
In patients with traumatic brain injury (TBI), intracranial hypertension secondary to cerebral edema is a major problem. A last-tier treatment in these cases is decompressive craniectomy. The aim of the present retrospective investigation was to (1) study the long-time outcome in patients with traumatic head injuries with intracranial hypertension treated with decompressive craniectomy; (2) examine the effects on intracranial pressure (ICP) by the craniectomy; and (3) investigate the possible relationship between the size of the removed bone-flap and the effects on ICP. Among the about 150 patients with severe TBI treated at our neurointensive care unit during 1997-2002, 19 patients were treated with decompressive craniectomy. All patients were young (mean 22 +/- 11 years, range 7-46 years), and 68% were male. The mean ICP was reduced from 29.2 +/- 3.5 before to 11.1 +/- 6.0 mm Hg immediately after the craniectomy; at 24 h after the craniectomy, the mean ICP was 13.9 +/- 9.7 mm Hg. Paired-samples t-test revealed a statistically significant decrease, both when comparing the preoperative values to the values immediately postoperative as well as to the values after 24 h (p < 0.01). A significant correlation between the size of the craniectomy and the decrease in ICP was found using Pearson regression analysis. The outcome of all patients could be assessed. The survival rate was 89%. Two patients died (both day 4 after the trauma); 68% of the patients had a favorable outcome (Glasgow Outcome Scale [GOS] score of 4 or 5); 16% were severely disabled (GOS score of 3); and one patient (5%) was left in a vegetative state.
在创伤性脑损伤（TBI）患者中，继发于脑水肿的颅内高压是一个主要问题。这些病例的最后一线治疗方法是去骨瓣减压术。本回顾性研究的目的是：（1）研究接受去骨瓣减压术治疗的颅内高压创伤性颅脑损伤患者的长期预后；（2）检查去骨瓣减压术对颅内压（ICP）的影响；（3）研究去除骨瓣的大小与对ICP影响之间的可能关系。在1997年至2002年期间，在我们的神经重症监护病房接受治疗的约150例重度TBI患者中，有19例接受了去骨瓣减压术。所有患者均较年轻（平均22±11岁，范围7至46岁），68%为男性。平均ICP从去骨瓣减压术前的29.2±3.5降至术后即刻的11.1±6.0 mmHg；去骨瓣减压术后24小时，平均ICP为13.9±9.7 mmHg。配对样本t检验显示，术前值与术后即刻值以及术后24小时的值相比，均有统计学意义的下降（p<0.01）。使用Pearson回归分析发现去骨瓣减压术的大小与ICP降低之间存在显著相关性。所有患者的预后均可评估。生存率为89%。2例患者死亡（均在创伤后第4天）；68%的患者预后良好（格拉斯哥预后量表[GOS]评分为4或5）；16%的患者严重残疾（GOS评分为3）；1例患者（5%）处于植物人状态。
