Grindlinger Gene A, Skavdahl David H, Ecker Robert D, Sanborn Matthew R
Maine Medical Center, 887 Congress Street, Suite 210, Portland, ME 04102 USA ; Tufts University School of Medicine, Boston, MA USA.
Surgical Residency Program, Maine Medical Center, Portland, ME USA ; Tufts University School of Medicine, Boston, MA USA.
Springerplus. 2016 Sep 20;5(1):1605. doi: 10.1186/s40064-016-3251-9. eCollection 2016.
To examine the clinical and neurological outcome of patients who sustained a severe non-penetrating traumatic brain injury (TBI) and underwent unilateral decompressive craniectomy (DC) for refractory intracranial hypertension.
Single center, retrospective, observational.
Level I Trauma Center in Portland, Maine.
31 patients aged 16-72 of either sex who sustained a severe, non-penetrating TBI and underwent a unilateral DC for evacuation of parenchymal or extra-axial hematoma or for failure of medical therapy to control intracranial pressure (ICP).
Review of the electronic medical record of patients undergoing DC for severe TBI and assessment of extended Glasgow Outcome Score (e-GOS) at 6-months following DC.
The mean age was 39.3y ± 14.5. The initial GCS was 5.8 ± 3.2, and the ISS was 29.7 ± 6.3. Twenty-two patients underwent DC within the first 24 h, two within the next 24 h and seven between the 3rd and 7th day post injury. The pre-DC ICP was 30.7 ± 10.3 and the ICP was 12.1 ± 6.2 post-DC. Cranioplasty was performed in all surviving patients 1-4 months post-DC. Of the 29 survivors following DC, the e-GOS was 8 in seven patients, and 7 in ten patients. The e-GOS was 5-6 in 6 others. Of the 6 survivors with poor outcomes (e-GOS = 2-4), five were the initial patients in the series.
In patients with intractable cerebral hypertension following TBI, unilateral DC in concert with practice guideline directed brain resuscitation is associated with good functional outcome and acceptable-mortality.
研究重度非穿透性创伤性脑损伤（TBI）患者接受单侧去骨瓣减压术（DC）治疗难治性颅内高压后的临床和神经学转归。
单中心、回顾性、观察性研究。
缅因州波特兰市的一级创伤中心。
31例年龄在16至72岁之间的男女患者，均为重度非穿透性TBI，因实质内或轴外血肿清除或药物治疗无法控制颅内压（ICP）而接受单侧DC。
回顾重度TBI患者接受DC的电子病历，并评估DC后6个月的扩展格拉斯哥预后评分（e-GOS）。
平均年龄为39.3岁±14.5岁。初始格拉斯哥昏迷量表（GCS）评分为5.8±3.2，损伤严重程度评分（ISS）为29.7±6.3。22例患者在伤后24小时内接受DC，2例在接下来的24小时内接受，7例在伤后第3天至第7天接受。DC术前ICP为30.7±10.3，DC术后ICP为12.1±6.2。所有存活患者在DC术后1至4个月进行颅骨修补术。DC术后29例存活患者中，7例e-GOS评分为8分，10例为7分。另外6例e-GOS评分为5至6分。在6例预后不良（e-GOS=2至4分）的存活患者中，5例是该系列中的初始患者。
在TBI后顽固性脑高压患者中，单侧DC联合实践指南指导的脑复苏与良好的功能转归及可接受的死亡率相关。
