Zhao He-Xiang, Liao Yi, Xu Ding, Wang Qiang-Ping, Gan Qi, You Chao, Yang Chao-Hua
Department of Neurosurgery, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan, 610041, P.R. China.
Department of Neuro-intensive care unit, West China Hospital, Sichuan University, No. 37 Guoxue Xiang, Chengdu, Sichuan, 610041, P.R. China.
BMC Surg. 2015 Oct 14;15:111. doi: 10.1186/s12893-015-0100-7.
The risk factors of predicting the need for postoperative decompressive craniectomy due to intracranial hypertension after primary craniotomy remain unclear. This study aimed to investigate the value of intraoperative intracranial pressure (ICP) monitoring in predicting re-operation using salvage decompressive craniectomy (SDC).
From January 2008 to October 2014, we retrospectively reviewed 284 patients with severe traumatic brain injury (STBI) who underwent craniotomy for mass lesion evacuation without intraoperative brain swelling. Intraoperative ICP was documented at the time of initial craniotomy and then again after the dura was sutured. SDC was used when postoperative ICP was continually higher than 25 mmHg for 1 h without a downward trend. Univariate and multivariate analyses were applied to both initial demographic and radiographic features to identify risk factors of SDC requirement.
Of 284, 41 (14.4%) patients who underwent SDC had a higher Initial ICP than those who didn't (38.1 ± 9.2 vs. 29.3 ± 8.1 mmHg, P < 0.001), but there was no difference in ICP after the dura was sutured. The factors which have significant effects on SDC are higher initial ICP [odds ratio (OR): 1.100, 95% confidence interval (CI): 1.052-1.151, P < 0.001], older age (OR: 1.039, 95% CI: 1.002-1.077, P = 0.039), combined lesions (OR: 3.329, 95% CI: 1.199-9.244, P = 0.021) and early hypotension (OR: 2.524, 95% CI: 1.107-5.756, P = 0.028). The area under the curve of multivariate regression model was 0.771.
The incidence of re-operation using SDC after craniotomy was 14.4%. The independent risk factors of SDC requirement are initial ICP, age, early hypotension and combined lesions.
原发性开颅术后因颅内高压而需要进行术后减压性颅骨切除术的危险因素仍不明确。本研究旨在探讨术中颅内压（ICP）监测在预测采用挽救性减压性颅骨切除术（SDC）再次手术方面的价值。
回顾性分析2008年1月至2014年10月期间284例重度创伤性脑损伤（STBI）患者，这些患者接受了开颅手术以清除占位性病变且术中无脑肿胀。在初次开颅时及硬脑膜缝合后记录术中ICP。当术后ICP持续高于25 mmHg达1小时且无下降趋势时采用SDC。对初始人口统计学和影像学特征进行单因素和多因素分析，以确定需要进行SDC的危险因素。
在284例患者中，41例（14.4%）接受了SDC，其初始ICP高于未接受SDC的患者（38.1±9.2 vs. 29.3±8.1 mmHg，P<0.001），但硬脑膜缝合后的ICP无差异。对SDC有显著影响的因素包括较高的初始ICP[比值比（OR）：1.100，95%置信区间（CI）：1.052 - 1.151，P<0.001]、年龄较大（OR：1.039，95%CI：1.002 - 1.077，P = 0.039）、合并损伤（OR：3.329，95%CI：1.
