Altieri Roberto, Cofano Fabio, Agnoletti Alessandro, Fornaro Riccardo, Ajello Marco, Zenga Francesco, Ducati Alessandro, Garbossa Diego
Department of Neurosurgery, University of Turin, Turin, Italy.
Department of Neurosurgery, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy.
J Neurol Surg A Cent Eur Neurosurg. 2018 Jan;79(1):25-30. doi: 10.1055/s-0037-1599238. Epub 2017 Mar 24.
Pressure on economic resources now requires a careful rationalization of services. For adult patients with supratentorial gliomas, there is no consensus on the real need for care in a postoperative neurocritical intensive care unit (NICU) and on the timing of a postsurgical computed tomography (CT) scan. In this retrospective nonrandomized study, we assessed if and when there is a real need for NICU and if an early CT scan could be justified in the absence of neurologic worsening.
Of 264 patients, 21 were admitted to the NICU after the procedure as planned before the surgery for their clinical features (Karnofsky performance status < 70, American Society of Anesthesiologists score > 2, or Charlson Comorbidity Index > 5).
The mean stay in the NICU was 19.7 hours. One of these patients had developed a postoperative hematoma that was subsequently removed, and died afterward. The other 243 patients were followed clinically after the procedure: 219 underwent a cerebral CT scan 24 hours after the procedure and were discharged in good condition. The other 24 patients had a cerebral CT scan within 24 hours after the procedure. The early CT showed the presence of a local edema in five cases and a hematoma surgically treated with a subsequent admission to the NICU in two cases.
Considering our data, we suggest that NICU should not always be used after craniotomy for supratentorial gliomas. Clinical observation was sufficient to predict early postoperative complications. A CT scan before 24 hours after surgery is not recommended in the absence of clinical worsening.
当前经济资源面临的压力要求对医疗服务进行仔细的合理化安排。对于幕上胶质瘤成年患者，术后神经重症监护病房（NICU）护理的实际需求以及术后计算机断层扫描（CT）的时间安排尚无共识。在这项回顾性非随机研究中，我们评估了是否以及何时真正需要入住NICU，以及在无神经功能恶化的情况下早期CT扫描是否合理。
264例患者中，21例因临床特征（卡诺夫斯基功能状态评分<70、美国麻醉医师协会评分>2或查尔森合并症指数>5）在手术前按计划术后入住NICU。
在NICU的平均停留时间为19.7小时。其中1例患者术后出现血肿，随后进行了清除，但最终死亡。其他243例患者术后接受临床随访：219例在术后24小时进行了脑部CT扫描，出院时情况良好。另外24例患者在术后24小时内进行了脑部CT扫描。早期CT显示5例存在局部水肿，2例存在血肿并接受手术治疗，随后入住NICU。
根据我们的数据，我们建议幕上胶质瘤开颅术后并非总是需要使用NICU。临床观察足以预测早期术后并发症。在无临床恶化的情况下，不建议在术后24小时内进行CT扫描。
