Mao Xiang, Miao Guozhuan, Hao Shuyu, Tao Xiaogang, Hou Zonggang, Li Huan, Tian Runfa, Zhang Hao, Lu Te, Ma Jun, Zhang Xiaodong, Cheng Hongwei, Liu Baiyun
Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China ; Nerve Injury and Repair Center of Beijing Institute for Brain Disorders, Capital Medical University, Beijing, People's Republic of China ; Neurotrauma Laboratory, Beijing Neurosurgical Institute, Capital Medical University, Beijing, People's Republic of China ; China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People's Republic of China.
Department of Neurotrauma, General Hospital of Armed Police Forces, Capital Medical University, Beijing, People's Republic of China.
Ther Clin Risk Manag. 2015 Oct 22;11:1627-33. doi: 10.2147/TCRM.S89820. eCollection 2015.
The outcome of decompressive craniectomy (DC) for severe traumatic brain injury (sTBI) patients with fixed dilated pupils (FDPs) is not clear. The objective of this study was to validate the outcome of DC in sTBI patients with FDPs.
We retrospectively collected data from 207 sTBI patients with FDPs during the time period of May 4, 2003-October 22, 2013: DC group (n=166) and conservative care (CC) group (n=41).
Outcomes that were used as indicators in this study were mortality and favorable outcome. The analysis was based on the Glasgow Outcome Scale recorded at 6 months after trauma.
A total of 49.28% patients died (39.76% [DC group] vs 87.80% [CC group]). The mean increased intracranial pressure values after admission before operation were 36.20±7.55 mmHg in the DC group and 35.59±8.18 mmHg in the CC group. After performing DC, the mean ICP value was 14.38±2.60 mmHg. Approximately, 34.34% sTBI patients with FDPs in the DC group gained favorable scores and none of the patients in the CC group gained favorable scores.
We found that DC plays a therapeutic role in sTBI patients with FDPs, and it is particularly important to reduce intracranial pressure as soon as possible after trauma. For the patients undergoing DC, favorable outcome and low mortality could be achieved.
对于伴有固定性瞳孔散大（FDPs）的重型颅脑损伤（sTBI）患者，减压性颅骨切除术（DC）的效果尚不清楚。本研究的目的是验证DC对伴有FDPs的sTBI患者的疗效。
我们回顾性收集了2003年5月4日至2013年10月22日期间207例伴有FDPs的sTBI患者的数据：DC组（n = 166）和保守治疗（CC）组（n = 41）。
本研究中用作指标的结果是死亡率和良好预后。分析基于创伤后6个月记录的格拉斯哥预后量表。
共有49.28%的患者死亡（DC组为39.76%，CC组为87.80%）。DC组入院后术前平均颅内压增加值为36.20±7.55 mmHg，CC组为35.59±8.18 mmHg。进行DC后，平均颅内压值为14.38±2.60 mmHg。DC组中约34.34%伴有FDPs的sTBI患者获得了良好评分，而CC组中没有患者获得良好评分。
我们发现DC对伴有FDPs的sTBI患者具有治疗作用，创伤后尽快降低颅内压尤为重要。对于接受DC的患者，可以实现良好的预后和低死亡率。
