Khan Farid, Valliani Arif, Rehman Abdul, Bari Muhammad Ehsan
Department of Surgery, Aga Khan University Hospital, Karachi 74800, Pakistan.
Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi 74800, Pakistan.
Asian J Neurosurg. 2018 Jul-Sep;13(3):730-736. doi: 10.4103/ajns.AJNS_6_18.
Factors affecting functional outcome after decompressive craniectomy (DC) performed for traumatic brain injury (TBI) remain poorly understood.
We conducted a retrospective study of all patients who underwent primary DC for TBI at our hospital between 2010 and 2014. Multivariate regression analyses were used to determine the predictors of functional outcome and overall survival.
A total of 98 patients with severe ( = 81, 82.6%) or moderate ( = 17, 17.4%) TBI underwent primary DC and were included in this study. The 30-day and overall mortality rates were 15.3% and 25.5%, respectively. At a median follow-up of 90 (interquartile range (IQR): 38-180) days, median Karnofsky Performance Status (KPS) and Glasgow outcome scale-extended (GOSE) scores were 50 (IQR: 20-70) and 5 (IQR: 3-7), respectively. Young age and severe TBI were predictors of mortality. Glasgow coma scale (GCS) score on discharge was a strong predictor of KPS and GOSE scores.
Primary DC afforded an acceptable functional outcome (GOSE score ≥5) in 45.9% of patients. Young age and lower GCS at presentation were associated with worse survival. GCS score on discharge was a strong predictor of functional outcome.
对于因创伤性脑损伤（TBI）而行减压性颅骨切除术（DC）后的功能预后影响因素，目前仍知之甚少。
我们对2010年至2014年间在我院因TBI接受初次DC的所有患者进行了一项回顾性研究。采用多变量回归分析来确定功能预后和总体生存率的预测因素。
共有98例重度（n = 81，82.6%）或中度（n = 17，17.4%）TBI患者接受了初次DC并纳入本研究。30天和总体死亡率分别为15.3%和25.5%。在中位随访90（四分位间距（IQR）：38 - 180）天时，中位卡诺夫斯基功能状态（KPS）和格拉斯哥扩展预后量表（GOSE）评分分别为50（IQR：20 - 70）和5（IQR：3 - 7）。年轻和重度TBI是死亡率的预测因素。出院时的格拉斯哥昏迷量表（GCS）评分是KPS和GOSE评分的有力预测因素。
初次DC使45.9%的患者获得了可接受的功能预后（GOSE评分≥5）。年轻和入院时较低的GCS与较差的生存率相关。出院时的GCS评分是功能预后的有力预测因素。
