Kim Young-Ju
Sungshin University, College of Nursing, Republic of Korea.
Int Emerg Nurs. 2014 Oct;22(4):214-9. doi: 10.1016/j.ienj.2014.02.005. Epub 2014 Feb 27.
To review the relationship between the time interval to surgery and outcomes in patients with traumatic brain injury (TBI).
A literature review was conducted by employing several search strategies, including electronic database searches and footnote chasing. The quality of the selected studies was assessed in terms of internal and external validity. Data regarding authors, publication year, sample size, surgical procedure, time interval to surgery, and outcome was extracted.
Among 16 finally selected studies, five studies (31.3%) found that patient outcome was significantly affected by the timing of surgery and 11 (68.7%) did not. The impact of time to surgery on outcomes was not significant in most (75%) of the studies targeting patients with severe TBI. The effect of time to surgery on outcome showed different findings depending on the type of surgical procedure. A significant effect of time to surgery on outcome was reported in one (14.2%) of the seven studies targeting patients who underwent haematoma evacuation and in four (44.4%) of the nine studies on patients who underwent decompressive craniectomy.
This review shows that current opinion is still divided regarding when to operate. Despite this discrepancy, most authors agree that the timing of decompression is crucial to outcome.
回顾创伤性脑损伤（TBI）患者手术时间间隔与预后之间的关系。
采用多种检索策略进行文献综述，包括电子数据库检索和参考文献追溯。根据内部和外部效度对所选研究的质量进行评估。提取有关作者、发表年份、样本量、手术方式、手术时间间隔和预后的数据。
在最终选定的16项研究中，5项研究（31.3%）发现手术时机对患者预后有显著影响，11项研究（68.7%）则未发现。在大多数（75%）针对重度TBI患者的研究中，手术时间对预后的影响并不显著。手术时间对预后的影响因手术方式而异。在针对接受血肿清除术患者的7项研究中，有1项（14.2%）报告手术时间对预后有显著影响；在针对接受去骨瓣减压术患者的9项研究中，有4项（44.4%）报告有显著影响。
本综述表明，目前对于何时进行手术仍存在分歧。尽管存在这种差异，但大多数作者一致认为减压时机对预后至关重要。
