奥地利连续患者系列中平民穿透性脑损伤的现场救治：损伤类型、原因及预后
Surviving the Scene in Civilian Penetrating Brain Injury: Injury Type, Cause and Outcome in a Consecutive Patient Series in Austria.
作者信息
Marhold Franz, Scheichel Florian, Ladisich Barbara, Pruckner Philip, Strasser Elisabeth, Themesl Melanie, Ungersboeck Karl, Popadic Branko
机构信息
Karl Landsteiner University of Health Sciences, Krems, Austria.
Department of Neurosurgery, University Hospital St. Poelten, St. Poelten, Austria.
出版信息
Front Surg. 2022 Jun 28;9:923949. doi: 10.3389/fsurg.2022.923949. eCollection 2022.
BACKGROUND
Penetrating brain injury (PBI) is a heterogeneous condition with many variables. Few data exist on civilian PBI. In some publications, PBI differentiation between low-velocity injury (LVI) and high-velocity injury (HVI) is made, but exact definitions are not given yet. The incidence of PBI depends heavily on the country of origin. Furthermore, captive bolt pistol (CBP) injuries represent a rare type of LVI and almost no reports exist in the human medical literature. Treatment of PBI has been controversially discussed due to high morbidity and mortality with results varying considerably between series. Prognostic factors are of utmost importance to identify patients who presumably benefit from treatment.
METHODS
A retrospective, single-center analysis of a consecutive patient series was performed from September 2005 to May 2018. We included all patients with PBI who reached our hospital alive and received any neurosurgical operative procedure.
RESULTS
Of 24 patients, 38% died, 17% had an unfavourable outcome, and 46% had a favourable outcome. In total, 58% of patients with PBI were self-inflicted. Leading causes of injury were firearms, while captive bolt pistols were responsible for 21% of injuries. LVI represented 54%, and HVI represented 46%. The outcome in HVI was significantly worse than that in LVI. A favourable outcome was achieved in 69% of LVI and 18% of HVI. Low GCS and pathological pupillary status at admission correlated significantly with an unfavourable outcome and death.
CONCLUSIONS
PBI is a heterogeneous injury with many variables and major geographical and etiological differences. Differentiation between LVI and HVI is crucial for decision-making and predicting outcomes. In patients presenting with object trajectories crossing the midline, no favourable outcome could be achieved. Nevertheless, in total, a favourable outcome was possible in almost half of the patients who succeeded in surgery.
背景
穿透性脑损伤（PBI）是一种具有多种变量的异质性疾病。关于平民PBI的数据很少。在一些出版物中，对低速损伤（LVI）和高速损伤（HVI）进行了PBI区分，但尚未给出确切定义。PBI的发病率在很大程度上取决于来源国。此外，栓式手枪（CBP）损伤是一种罕见的LVI类型，人类医学文献中几乎没有相关报道。由于PBI的高发病率和死亡率，且各系列结果差异很大，因此对其治疗一直存在争议。预后因素对于识别可能从治疗中获益的患者至关重要。
方法
对2005年9月至2018年5月连续的患者系列进行回顾性单中心分析。我们纳入了所有存活到达我院并接受任何神经外科手术的PBI患者。
结果
24例患者中，38%死亡，17%预后不良，46%预后良好。PBI患者中，58%为自残。主要损伤原因是枪支，而栓式手枪造成的损伤占21%。LVI占54%，HVI占46%。HVI的预后明显比LVI差。LVI患者中69%预后良好，HVI患者中18%预后良好。入院时低格拉斯哥昏迷评分（GCS）和病理性瞳孔状态与不良预后和死亡显著相关。
结论
PBI是一种具有多种变量以及主要地理和病因差异的异质性损伤。LVI和HVI的区分对于决策和预测结果至关重要。对于物体轨迹穿过中线的患者，无法获得良好预后。然而，总体而言，几乎一半成功接受手术的患者有可能获得良好预后。
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