Kalayci Murat, Aktunç Erol, Gül Sanser, Hanci Volkan, Edebali Nurullah, Cagavi Ferda, Açikgöz Bektas
Department of Neurosurgery, Zonguldak Karaelmas University Medical School, Turkey.
J Pak Med Assoc. 2013 Jan;63(1):38-49.
To identify specific factors that can be used to predict functional outcome and to assess the value of decompressive craniectomy in patients with acute subdural haematoma.
The retrospective study was done at the Zonguldak Karaelwas University Practice and Research Hospital, Turkey, and included 34 trauma patients who had undergone decompressive craniectomy for acute subdural haematoma from 2001 to 2009. At the 30th day of the operation, the patients were grouped as survivors and non-survivors. Besides, based on their Glasgow Outcome Scale, which was calculated 6 months postoperatively, the patients were divided into two functional groups: favourable outcomes (4-5 on the scale), and unfavourable outcomes (1-3 on the scale). The characteristics of the groups were compared using SPSS 15 for statistical analysis.
One-month mortality was 38.2% (n = 13) and 6-month total mortality reached 47% (n = 16). Patients with higher pre-operative revised trauma score, Glasgow coma scale, partial anterial pressure of carbon dioxide, arterial oxygen pressure, Charlson co-morbidity index score, blood glucose level, blood urea nitrogen, and lower age had a higher rate of survival and consequently a favourable outcome. Higher platelet values were only found to be a determinant of higher survival at the end of the first month without having any significant effect on the favourable outcome.
In patients of traumatic acute subdural haematoma whose Glasgow coma scale on arrival was < or = 8, a massive craniectomy along with the evacuation of the haematoma, may be considered as a treatment option for intra-operative and post-operative brain swelling. But in patients with a score of 3 on arrival and bilaterally fixed and dilated pupils, decompressive craniectomy is unnecessary.
确定可用于预测功能结局的特定因素，并评估急性硬膜下血肿患者行减压性颅骨切除术的价值。
本回顾性研究在土耳其宗古尔达克卡拉埃尔马斯大学实践与研究医院进行，纳入了2001年至2009年间因急性硬膜下血肿接受减压性颅骨切除术的34例创伤患者。在手术第30天，将患者分为幸存者和非幸存者。此外，根据术后6个月计算的格拉斯哥预后量表，将患者分为两个功能组：良好结局（量表评分为4 - 5分）和不良结局（量表评分为1 - 3分）。使用SPSS 15对各组特征进行比较以进行统计分析。
1个月死亡率为38.2%（n = 13），6个月总死亡率达47%（n = 16）。术前修正创伤评分、格拉斯哥昏迷量表评分、二氧化碳分压、动脉血氧分压、查尔森合并症指数评分、血糖水平、血尿素氮较高且年龄较低的患者生存率较高，因此结局良好。仅发现较高的血小板值是第一个月末较高生存率的决定因素，对良好结局无任何显著影响。
对于入院时格拉斯哥昏迷量表评分≤8分的创伤性急性硬膜下血肿患者，可考虑行大骨瓣开颅术并清除血肿，作为术中及术后脑肿胀的一种治疗选择。但对于入院时评分为3分且双侧瞳孔固定散大的患者，无需进行减压性颅骨切除术。
