Rea G L, Rockswold G L
Neurosurgery. 1983 Apr;12(4):401-4. doi: 10.1227/00006123-198304000-00005.
From July 1978 to September 1981, 27 patients from a group of 210 patients with severe head injuries developed uncontrolled intracranial hypertension despite intensive medical and surgical management. These 27 patients were considered appropriate candidates for barbiturate therapy. Abnormal posturing or flaccidity was present in 70% of the patients, and 41% had bilaterally fixed pupils. Twenty-five of 27 patients had mass lesions requiring operation. Of the 15 patients who responded to barbiturate therapy with normalization of intracranial pressure for 24 hours, 5 died (33% mortality). Nine of the 12 patients who did not respond to the barbiturate therapy died (75% mortality). The total mortality in this group of 27 patients was 52%. Of the survivors, 69% had a recovery classified as good recovery/moderate disability, and 31% were in a severe disability/vegetative state. The morbidity and mortality in these patients is high, but comparisons with previous studies show that this is a selected group of severe head injuries with a high percentage of poor prognostic indicators. Our experience suggests that barbiturates can be effective in lowering intracranial pressure in patients with otherwise unresponsive intracranial hypertension, and, by doing so, may decrease the mortality in a group of patients considered untreatable by the usual therapeutic modalities.
1978年7月至1981年9月，在210例重型颅脑损伤患者中，有27例尽管接受了强化药物和手术治疗，仍出现了难以控制的颅内高压。这27例患者被认为是巴比妥类药物治疗的合适人选。70%的患者存在异常姿势或弛缓，41%的患者双侧瞳孔固定。27例患者中有25例有需要手术的占位性病变。在15例对巴比妥类药物治疗有反应、颅内压在24小时内恢复正常的患者中，5例死亡（死亡率33%）。在12例对巴比妥类药物治疗无反应的患者中，9例死亡（死亡率75%）。这27例患者的总死亡率为52%。在幸存者中，69%的恢复情况被归类为良好恢复/中度残疾，31%处于严重残疾/植物状态。这些患者的发病率和死亡率很高，但与以往研究的比较表明，这是一组具有高比例不良预后指标的重型颅脑损伤患者。我们的经验表明，巴比妥类药物可有效降低颅内压难以控制的患者的颅内压，并且通过这样做，可能会降低一组被认为无法通过常规治疗方式治疗的患者的死亡率。
