Khan Abid D, Elseth Anna J, Head Brian, Rostas Jack, Dunn Julie A, Schroeppel Thomas J, Gonzalez Richard P
Am Surg. 2017 Aug 1;83(8):836-841.
The role of decompressive craniectomy (DC) for severe traumatic brain injury (STBI) remains controversial. The purpose of this study was to identify factors that are indicators of survival and improved functional outcome in patients who undergo DC for STBI. A retrospective review of STBI patients who underwent DC was performed at four trauma centers during a 45-month period. Data collected included age, gender, mechanism of injury, Injury Severity Score (ISS), admission Glasgow Coma Scale (GCS), time from admission to DC, mortality, and extended Glasgow Outcome Score before discharge. Sixty-nine STBI patients were treated with DC during the study period. A higher initial GCS, lower ISS, and longer time to DC were all statistically significant for improved survival after DC. A younger age, higher initial GCS, and lower ISS were all statistically significant for a favorable functional outcome after DC. Patients with a higher initial GCS and lower ISS are more likely to survive DC and have a favorable functional outcome, whereas a longer time to DC was indicative of improved survival after DC.
减压性颅骨切除术（DC）在重度创伤性脑损伤（STBI）中的作用仍存在争议。本研究的目的是确定在接受DC治疗的STBI患者中作为生存指标和功能转归改善指标的因素。在45个月期间，对四个创伤中心接受DC治疗的STBI患者进行了回顾性研究。收集的数据包括年龄、性别、损伤机制、损伤严重程度评分（ISS）、入院时格拉斯哥昏迷量表（GCS）、从入院到DC的时间、死亡率以及出院前的扩展格拉斯哥预后评分。在研究期间，69例STBI患者接受了DC治疗。较高的初始GCS、较低的ISS以及较长的至DC时间对DC术后生存改善均具有统计学意义。较年轻的年龄、较高的初始GCS以及较低的ISS对DC术后良好的功能转归均具有统计学意义。初始GCS较高且ISS较低的患者更有可能在DC术后存活并获得良好的功能转归，而较长的至DC时间表明DC术后生存改善。
