Otago Bioethics Centre, University of Otago Medical School, 201 Great King St, Dunedin (PO Box 913), New Zealand.
J Med Ethics. 2010 Dec;36(12):727-30. doi: 10.1136/jme.2010.037424. Epub 2010 Sep 18.
Decompressive craniectomy is a technically straightforward procedure whereby a large section of the cranium is temporarily removed in cases where the intracranial pressure is dangerously high. While its use has been described for a number of conditions, it is increasingly used in the context of severe head injury. As the use of the procedure increases, a significant number of patients may survive a severe head injury who otherwise would have died. Unfortunately some of these patients will be left severely disabled; a condition likened to the RUB, an acronym for the Risk of Unacceptable Badness. Until recently it has been difficult to predict this outcome, however an accurate prediction model has been developed and this has been applied to a large cohort of patients in Western Australia. It is possible to compare the predicted outcome with the observed outcome at 18 months within this cohort. By using predicted and observed outcome data this paper considers the ethical implications in three cases of differing severity of head injury in view of the fact that it is possible to calculate the RUB for each case.
去骨瓣减压术是一种技术上简单直接的手术，当颅内压过高时，暂时切除颅骨的一大块。虽然已经描述了其在多种情况下的应用，但它在严重头部损伤的情况下越来越多地被使用。随着该手术的应用增加，大量可能因严重头部损伤而死亡的患者得以幸存。不幸的是，其中一些患者会留下严重残疾；这种情况类似于 RUB，是不可接受的糟糕风险的缩写。直到最近，很难预测这种结果，然而，已经开发出了一种准确的预测模型，并将其应用于西澳大利亚的一大群患者中。在这个队列中，有可能将预测结果与 18 个月的观察结果进行比较。通过使用预测和观察到的结果数据，本文考虑了在三种不同严重程度的头部损伤情况下的伦理含义，因为有可能为每个病例计算 RUB。
