Liu Ziyuan, Du Shan, Wu Yun, Chen Tiange, Luo Xiangying, Bi Changlong, Lan Song, Chen Xin, Liu Jinfang
Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
J Neurotrauma. 2022 Sep;39(17-18):1231-1239. doi: 10.1089/neu.2021.0499. Epub 2022 Jul 22.
This study aimed to address the risk factors of second decompressive craniectomy (DC) in patients with traumatic brain injury (TBI) who initially underwent mass lesion evacuation, but no primary DC. Patients were enrolled if they had had a hospital visit to Xiangya Hospital, Central South University with acute closed TBI from January 1, 2017 to December 31, 2019 and had undergone craniotomic mass lesion evacuation. Sociodemographic information, computed tomography (CT) information, clinical profiles, and surgical information were obtained from an electronic database. Twenty-four patients who had undergone a second decompressive craniectomy (SDC) and 39 patients who had not (NSO) were included in the analysis. The prevailing lesions differed between the groups ( = 0.010). The SDC group had more compressed/obliterated basal cisterns than the NSO group ( = 0.028). After closure of the dura, the SDC group also had higher intracranial pressure (ICP) than the NSO group (10.9 mm Hg vs. 6.5 mm Hg, = 0.005). Binary logistical regression indicated that ICP after dura closure was an independent predictor of second DC (odds ratio [OR] = 1.317, = 0.011). A model using ICP after dura closure alone had an area under the curve value of 0.757 in its receiver operating characteristic curve. An ICP >10.5 mm Hg after closure of dura for the prediction of a second DC had a sensitivity of 56.3% and a specificity of 92.6%.
本研究旨在探讨创伤性脑损伤（TBI）患者首次行占位性病变清除术但未行一期减压性颅骨切除术（DC）后，二次减压性颅骨切除术（DC）的危险因素。纳入2017年1月1日至2019年12月31日期间因急性闭合性TBI到中南大学湘雅医院就诊并接受开颅占位性病变清除术的患者。从电子数据库中获取社会人口学信息、计算机断层扫描（CT）信息、临床资料和手术信息。分析纳入了24例行二次减压性颅骨切除术（SDC）的患者和39例未行二次减压性颅骨切除术（NSO）的患者。两组间主要病变不同（P = 0.010）。SDC组比NSO组有更多受压/闭塞的基底池（P = 0.028）。硬脑膜关闭后，SDC组的颅内压（ICP）也高于NSO组（10.9 mmHg对6.5 mmHg，P = 0.005）。二元逻辑回归表明，硬脑膜关闭后的ICP是二次DC的独立预测因素（比值比[OR] = 1.317，P = 0.011）。仅使用硬脑膜关闭后的ICP构建的模型在其受试者工作特征曲线下的面积值为0.757。硬脑膜关闭后ICP>10.5 mmHg预测二次DC的敏感性为56.3%，特异性为92.6%。
