Kretschmer H
Aktuelle Traumatol. 1983 Aug;13(4):139-44.
In a retrospective, non-randomised study, the author examined the influence of additional drug treatment on the prognosis of severe injuries of the skull and brain. The emphasis of this study was on treatment with dexamethasone and barbiturates. Of 489 injured persons, 260 were treated with dexamethasone and 229 by the conventional standard treatment method only. Evaluation of the results showed that the high-dosage dexamethasone therapy clearly reduced the mortality in severe injuries of the skull and brain (from 57.4% to 32.4%), although this partly resulted in an increase of defective conditions. On the other hand, no definite effect of treatment was noticeable in extremeLy severe cases with high-grade substantial brain damage and with the milder forms of trauma in which the traumatic brain oedema did not play a prominent role. Barbiturates were used only where it proved impossible to reduce the increased brain pressure by other means. Good remissions were seen in some patients, but the total number is insufficient for a final evaluation. Independent of the treatment, however, other factors (depth and duration of the initial disturbance of consciousness, age, concomitant injuries) exercise a significant influence on the prognosis of severe injuries of the skull and brain.
在一项回顾性、非随机研究中，作者研究了附加药物治疗对严重颅脑损伤预后的影响。该研究重点在于地塞米松和巴比妥类药物的治疗。在489名伤者中，260人接受了地塞米松治疗，229人仅采用传统标准治疗方法。结果评估显示，高剂量地塞米松疗法明显降低了严重颅脑损伤的死亡率（从57.4%降至32.4%），尽管这在一定程度上导致了残疾情况的增加。另一方面，在极重度且伴有严重脑损伤以及创伤性脑水肿不起主要作用的较轻创伤形式的病例中，未观察到明显的治疗效果。仅在无法通过其他手段降低颅内压升高的情况下使用巴比妥类药物。部分患者病情明显缓解，但总数不足以进行最终评估。然而，与治疗无关，其他因素（初始意识障碍的深度和持续时间、年龄、并发损伤）对严重颅脑损伤的预后有显著影响。
