Department of Intensive Care Medicine, Royal Perth Hospital, School of Population Health, University of Western Australia, Western Australia.
Crit Care Med. 2011 Nov;39(11):2495-500. doi: 10.1097/CCM.0b013e318225764e.
This study aimed to assess the incidence and factors associated with delayed neurologic recovery after decompressive craniectomy for severe nonpenetrating traumatic brain injury.
Retrospective cohort study.
Two major neurotrauma centers in Western Australia.
One hundred and four adult neurotrauma patients who had had a decompressive craniectomy and remained moderately disabled or worse at 6-month follow-up.
Glasgow Outcome Scale scores at 6, 12, and 18 months were used to assess the neurologic recovery of the patients, and logistic regression was used to identify the factors associated with delayed neurologic recovery between 6 and 18 months after surgery. Among a total of 176 patients who required decompressive craniectomy between 2004 and 2010, 104 (59%) had moderate to severe disability 6 months after surgery. Fifty of these patients (48%, 95% confidence interval: 39-58) had ≥ 1 grade of improvement in Glasgow Outcome Scale score between 6 and 18 months after surgery. Of the 59 patients who had an unfavorable outcome (severe disability or vegetative state) 6 months after surgery, 15 patients (25%, 95% confidence interval: 16-38) improved and had attained a favorable outcome (moderate disability or near normal neurologic function) by the 18-month follow-up. An absence of nonevacuated intracerebral hematoma (>1 cm in diameter) (odds ratio 6.67, 95% confidence interval: 1.12-33.3; p = .038) and a higher admission Glasgow Coma Scale (odds ratio per point increment 1.44, 95% confidence interval: 1.07-1.96; p = .018) were the only two factors significantly associated with a higher chance of delayed neurologic improvement from unfavorable to favorable neurologic outcome between 6 and 18 months after surgery.
Delayed neurologic recovery after decompressive craniectomy for severe nonpenetrating traumatic brain injury was very common; absence of nonevacuated intracerebral hematoma and a high admission Glasgow Coma Scale were associated with a higher chance of delayed neurologic recovery after decompressive craniectomy.
本研究旨在评估去骨瓣减压术治疗严重非穿透性创伤性脑损伤后神经功能延迟恢复的发生率和相关因素。
回顾性队列研究。
西澳大利亚州的两个主要神经创伤中心。
104 名成人神经创伤患者，减压手术后 6 个月时仍处于中度残疾或更差状态。
使用格拉斯哥结局量表（Glasgow Outcome Scale）评分在 6、12 和 18 个月评估患者的神经恢复情况，并使用逻辑回归识别手术 6 至 18 个月后与神经功能延迟恢复相关的因素。在 2004 年至 2010 年间需要行去骨瓣减压术的 176 名患者中，104 名（59%）在手术后 6 个月时存在中重度残疾。这 104 名患者中有 50 名（48%，95%置信区间：39-58）在手术后 6 至 18 个月期间格拉斯哥结局量表评分至少提高了 1 个等级。在手术后 6 个月时预后不良（重度残疾或植物状态）的 59 名患者中，15 名（25%，95%置信区间：16-38）在 18 个月随访时改善并获得了较好的结局（中重度残疾或接近正常的神经功能）。未排空的颅内血肿（>1 厘米直径）的缺失（优势比 6.67，95%置信区间：1.12-33.3；p =.038）和较高的入院格拉斯哥昏迷量表评分（每增加 1 分的优势比 1.44，95%置信区间：1.07-1.96；p =.018）是手术后 6 至 18 个月间从不良神经结局到有利神经结局的神经功能延迟改善的唯一两个显著相关因素。
去骨瓣减压术治疗严重非穿透性创伤性脑损伤后神经功能延迟恢复非常常见；未排空的颅内血肿的缺失和较高的入院格拉斯哥昏迷量表评分与去骨瓣减压术后神经功能延迟恢复的可能性增加相关。
