行双侧去骨瓣减压术的 TBI 患者的特征和治疗概况：151 例病例的经验。
Characteristics and therapeutic profile of TBI patients who underwent bilateral decompressive craniectomy: experience with 151 cases.
机构信息
Department of Neurosurgery, National Center for Neurological Disorders, Neurosurgical Institute of Fudan University, Shanghai Clinical Medical Center of Neurosurgery, Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
Department of Neurosurgery and Neurocritical Care, Huashan Hospital, Fudan University, Shanghai, 200040, China.
出版信息
Scand J Trauma Resusc Emerg Med. 2022 Nov 17;30(1):59. doi: 10.1186/s13049-022-01046-w.
BACKGROUND
Decompressive craniectomy (DC) and intracranial pressure (ICP) monitoring are common approaches to reduce the death rate of Traumatic brain injury (TBI) patients, but the outcomes of these patients are unfavorable, particularly those who receive bilateral DC. The authors discuss their experience using ICP and other potential methods to improve the outcomes of TBI patients who receive bilateral DC.
METHODS
Data from TBI patients receiving bilateral DC from Jan. 2008 to Jan. 2022 were collected via a retrospective chart review. Included patients who received unplanned contralateral DC after initial surgery were identified as unplanned secondary surgery (USS) patients. Patients' demographics and baseline medical status; pre-, intra-, and postoperative events; and follow-up visit outcome data were analyzed.
RESULTS
A total of 151 TBI patients were included. Patients who underwent USS experienced more severe outcomes as assessed using the 3-month modified Rankin Scale score (P = 0.024). In bilateral DC TBI patients, USS were associated with worsen outcomes, moreover, ICP monitoring was able to lower their death rate and was associated with a lower USS incidence. In USS patients, ICP monitoring was not associated with improved outcomes but was able to lower their mortality rate (2/19, 10.5%, vs. 10/25, 40.0%; P = 0.042).
CONCLUSION
The avoidance of USS may be associated with improved outcomes of TBI patients who underwent bilateral DC. ICP monitoring was a potential approach to lower USS rate in TBI patients, but its specific benefits were uncertain.
背景
去骨瓣减压术（DC）和颅内压（ICP）监测是降低创伤性脑损伤（TBI）患者死亡率的常见方法，但这些患者的预后仍不理想，尤其是接受双侧 DC 的患者。作者讨论了他们使用 ICP 和其他潜在方法改善接受双侧 DC 的 TBI 患者预后的经验。
方法
通过回顾性病历分析，收集了 2008 年 1 月至 2022 年 1 月期间接受双侧 DC 的 TBI 患者的数据。将初始手术后接受计划外对侧 DC 的患者确定为计划外二次手术（USS）患者。分析了患者的人口统计学和基线医疗状况；术前、术中、术后事件；以及随访就诊结果数据。
结果
共纳入 151 例 TBI 患者。使用 3 个月改良 Rankin 量表评分评估，USS 患者的预后更差（P = 0.024）。在双侧 DC TBI 患者中，USS 与预后恶化相关，此外，ICP 监测可降低死亡率，并与 USS 发生率降低相关。在 USS 患者中，ICP 监测与改善预后无关，但可降低死亡率（2/19，10.5%，vs. 10/25，40.0%；P = 0.042）。
结论
避免 USS 可能与接受双侧 DC 的 TBI 患者的预后改善相关。ICP 监测是降低 TBI 患者 USS 发生率的一种潜在方法，但具体获益尚不确定。
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