Schoen Clinic Bad Aibling, Bad Aibling, Germany.
Institute for Stroke and Dementia Research (ISD), University of Munich Medical Center, Munich, Germany.
Crit Care Med. 2020 Aug;48(8):1157-1164. doi: 10.1097/CCM.0000000000004387.
Traumatic brain injury is the number one cause of death in children and young adults and has become increasingly prevalent in the elderly. Decompressive craniectomy prevents intracranial hypertension but does not clearly improve physical outcome 6 months after traumatic brain injury. However, it has not been analyzed if decompressive craniectomy affects traumatic brain injury patients' quality of life in the long term.
Therefore, we conducted a cross-sectional study assessing health-related quality of life in traumatic brain injury patients with or without decompressive craniectomy up to 10 years after injury.
Former critical care patients.
Chronic traumatic brain injury patients having not (n = 37) or having received (n = 98) decompressive craniectomy during the acute treatment.
Decompressive craniectomy was necessary in all initial traumatic brain injury severity groups. Eight percent more decompressive craniectomy patients reported good health-related quality of life with a Quality of Life after Brain Injury total score greater than or equal to 60 compared with the no decompressive craniectomy patients up to 10 years after traumatic brain injury (p = 0.004). Initially, mild classified traumatic brain injury patients had a median Quality of Life after Brain Injury total score of 83 (decompressive craniectomy) versus 62 (no decompressive craniectomy) (p = 0.028). Health-related quality of life regarding physical status was better in decompressive craniectomy patients (p = 0.025). Decompressive craniectomy showed a trend toward better health-related quality of life in the 61-85-year-old reflected by median Quality of Life after Brain Injury total scores of 62 (no decompressive craniectomy) versus 79 (decompressive craniectomy) (p = 0.06).
Our results suggest that decompressive craniectomy is associated with good health-related quality of life up to 10 years after traumatic brain injury. Thus, decompressive craniectomy may have an underestimated therapeutic potential after traumatic brain injury.
创伤性脑损伤是儿童和青年人群的头号死因，并且在老年人中发病率日益增高。去骨瓣减压术可预防颅内压升高，但在创伤性脑损伤后 6 个月并不能明显改善患者的身体预后。然而，目前尚不清楚去骨瓣减压术是否会长期影响创伤性脑损伤患者的生活质量。
因此，我们进行了一项横断面研究，评估创伤性脑损伤患者在受伤后 10 年内有无去骨瓣减压术的健康相关生活质量。
原重症监护病房患者。
慢性创伤性脑损伤患者，未（n = 37）或已（n = 98）在急性期行去骨瓣减压术。
所有初始创伤性脑损伤严重程度组均需要行去骨瓣减压术。与未行去骨瓣减压术的患者相比，8%更多的行去骨瓣减压术患者报告生活质量良好，创伤性脑损伤后 10 年的健康相关生活质量总评分大于或等于 60（QoLBIT 总分）（p = 0.004）。最初，轻度分类的创伤性脑损伤患者的 QoLBIT 总分中位数为 83（去骨瓣减压术），而 62（未行去骨瓣减压术）（p = 0.028）。行去骨瓣减压术患者的身体状况健康相关生活质量更好（p = 0.025）。去骨瓣减压术在 61-85 岁人群中表现出更好的健康相关生活质量的趋势，其 QoLBIT 总分中位数为 62（未行去骨瓣减压术）和 79（行去骨瓣减压术）（p = 0.06）。
我们的结果表明，创伤性脑损伤后 10 年内行去骨瓣减压术与良好的健康相关生活质量相关。因此，去骨瓣减压术在创伤性脑损伤后可能具有被低估的治疗潜力。
