Division of Neurosurgery, Department of Surgery, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Division of Neurosurgery, Department of Surgery, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
World Neurosurg. 2022 Jun;162:e652-e658. doi: 10.1016/j.wneu.2022.03.102. Epub 2022 Mar 28.
Decompressive craniectomy (DC) is an important therapy for treating intracranial pressure elevation following traumatic brain injury (TBI). During this procedure, about one-third of patients become complicated with intraoperative hypotension (IH), which is associated with abruptly decreasing sympathetic activity resulting from brain decompression. This study aimed to identify factors associated with IH during DC procedures and the mortality rate in these patients.
The records of adult TBI patients aged 18 years and older who underwent DC at Songklanagarind Hospital between January 2014 and January 2021 were retrospectively reviewed. Using logistic regression analysis, various factors were analyzed for their associations with IH during the DC procedures.
This study included 83 patients. The incidence of IH was 54%. Multivariate analysis showed that Glasgow Coma Scale motor response (GCS-M) 1-3 (vs. 4-6), higher preoperative heart rate (PHR), and larger amount of intraoperative blood loss were significantly associated with IH (P = 0.013, P < 0.001, and P < 0.001, respectively). Patients with GCS-M 1-3 and PHR ≥ 75 bpm had the highest chance of IH (77%), while patients with neither of these risk factors had the lowest chance (29%). The in-hospital mortality rate in the IH and non-IH groups was 44% and 26%, respectively (P = 0.138).
GCS-M 1-3, higher PHR, and larger amount of intraoperative blood loss were the risk factors associated with IH during DC procedure in TBI patients. Patients who have these risk factors should be closely monitored and the attending physician be ready to apply prompt resuscitation and treatment for IH.
去骨瓣减压术（DC）是治疗创伤性脑损伤（TBI）后颅内压升高的重要治疗方法。在此过程中，约有三分之一的患者出现术中低血压（IH），这与脑减压导致交感神经活动突然下降有关。本研究旨在确定与 DC 过程中 IH 相关的因素以及这些患者的死亡率。
回顾性分析 2014 年 1 月至 2021 年 1 月在宋卡王子大学医院接受 DC 的成年 TBI 患者的记录。使用逻辑回归分析，分析各种因素与 DC 过程中 IH 的关系。
本研究共纳入 83 例患者。IH 的发生率为 54%。多变量分析显示，格拉斯哥昏迷量表运动反应（GCS-M）1-3（vs. 4-6）、较高的术前心率（PHR）和较大的术中出血量与 IH 显著相关（P=0.013，P<0.001 和 P<0.001）。GCS-M 1-3 和 PHR≥75bpm 的患者 IH 的几率最高（77%），而两者均无这些危险因素的患者 IH 的几率最低（29%）。IH 组和非 IH 组的院内死亡率分别为 44%和 26%（P=0.138）。
GCS-M 1-3、较高的 PHR 和较大的术中出血量是 TBI 患者 DC 过程中与 IH 相关的危险因素。具有这些危险因素的患者应密切监测，主治医生应准备好对 IH 进行及时复苏和治疗。
