Karimi-Nejad A
Klinik für Neurochirurgie, Universität Köln.
Zentralbl Chir. 1994;119(3):184-7.
Cerebral lesions of variable severity lead to systemic and intracranial reactions. These create secondary brain damage due to hypoxia and ischemia. The causes as well as the sequelae of secondary brain damage necessitate long-term intensive care treatment with high technical and personal expenditure. This expensive treatment, however, remains unsuccessful in a large number of patients. 60% to 70% of the lethal courses following head trauma are found during the first 2 to 3 days. In those cases which succumb after weeks or less frequently after months in spite of intensive care treatment, the question of early limitation of intensive care seems reasonable. However, only a reliable early prediction of the unfavorable outcome can justify the limitation of unsuccessful intensive care treatment. Early prediction with respect to survival or lethal course is usually possible within the first two weeks following trauma. The early prediction with respect to later disability however is highly limited during the acute phase. The decision to limit treatment should be based on the numerous national and international statistical models and discussed on an individual basis, excluding even a 5% chance of survival. Early information of the family on the probable prognosis is useful. Their participation in the process of decision can be assessed only on an individual basis.
不同严重程度的脑损伤会引发全身和颅内反应。这些反应会因缺氧和缺血导致继发性脑损伤。继发性脑损伤的病因及后遗症需要长期的重症监护治疗，这会带来高昂的技术和人力成本。然而，这种昂贵的治疗在大量患者中并不成功。60%至70%的头部创伤致死病例发生在最初的2至3天内。在那些尽管接受了重症监护治疗，但仍在数周后或较少见地在数月后死亡的病例中，早期限制重症监护似乎是合理的。然而，只有可靠的早期不良预后预测才能证明限制无效的重症监护治疗是合理的。关于生存或致死病程的早期预测通常在创伤后的头两周内是可行的。然而，在急性期，关于后期残疾的早期预测非常有限。限制治疗的决定应基于众多国内外统计模型，并根据个体情况进行讨论，即使生存几率低于5%也应排除。尽早向家属告知可能的预后情况是有益的。他们对决策过程的参与只能根据个体情况进行评估。
