Kim Young-Il, Park Seung-Won, Nam Taek-Kyun, Park Yong-Sook, Min Byung-Kook, Hwang Sung-Nam
Department of Neurological Surgery, Chung-Ang University Yongsan Hospital, Seoul, Korea.
J Korean Neurosurg Soc. 2008 Sep;44(3):141-5. doi: 10.3340/jkns.2008.44.3.141. Epub 2008 Sep 30.
Barbiturate coma therapy (BCT) has been known to be an useful method to control increased intracranial pressure (IICP) refractory to medical and surgical treatments. We have used BCT for patients with severe IICP during the past 10 years, and analyzed our results with review of literatures.
We analyzed 92 semicomatose or comatose patients with Glasgow coma scale (GCS) of 7 or less with severe IICP due to cerebral edema secondary to parenchymal damages irrespective of their causes. Forty patients who had received BCT with ICP monitoring from January 1997 to December 2006 were included in BCT group, and fifty-two patients who had been managed without BCT from January 1991 to December 1995 were divided into control group. We compared outcomes with Glasgow outcome scale (GOS) and survival rate between the two groups.
Good outcome (GOS=4 and 5) rates at 3-month after insult were 27.5% and 5.8% in BCT and control group, respectively (p<0.01). One-year survival rates were 35.9% and 12.5% in BCT and control group, respectively (p<0.01). In BCT group, the mean age of good outcome patients (37.1 +/- 14.9) was significantly lower than that of poor outcome patients (48.1 +/- 13.5) (p<0.05).
With our 10-year experience, we suggest that BCT is an effective treatment method for severe IICP patients for better survival and GOS, especially for younger patients.
巴比妥昏迷疗法（BCT）已知是一种控制经药物和手术治疗后仍难以控制的颅内压升高（IICP）的有效方法。在过去10年中，我们已将BCT用于重度IICP患者，并结合文献回顾分析了我们的结果。
我们分析了92例格拉斯哥昏迷量表（GCS）为7分及以下的半昏迷或昏迷患者，这些患者因实质损伤继发脑水肿导致重度IICP，无论其病因如何。1997年1月至2006年12月期间接受BCT并进行ICP监测的40例患者纳入BCT组，1991年1月至1995年12月期间未接受BCT治疗的52例患者分为对照组。我们比较了两组之间的格拉斯哥预后量表（GOS）结局和生存率。
受伤后3个月时，BCT组和对照组的良好结局（GOS = 4和5）率分别为27.5%和5.8%（p < 0.01）。BCT组和对照组的1年生存率分别为35.9%和12.5%（p < 0.01）。在BCT组中，良好结局患者的平均年龄（37.1 +/- 14.9）显著低于不良结局患者（48.1 +/- 13.5）（p < 0.05）。
基于我们10年的经验，我们认为BCT是治疗重度IICP患者以提高生存率和GOS的有效方法，尤其是对于年轻患者。
