Resnick D K, Marion D W, Carlier P
University of Pittsburgh School of Medicine, Department of Neurological Surgery, Pennsylvania 15213-2582, USA.
J Trauma. 1997 Jun;42(6):1108-11. doi: 10.1097/00005373-199706000-00021.
To describe the functional outcome of a select group of patients with severe head injuries who would a priori be assumed to have a dismal outcome and to determine prognostic factors that can be used for effective family counseling and rational utilization of scarce resources.
Thirty-seven patients with severe head injuries (admission Glasgow Coma Scale (GCS) score < 8) with prolonged (> 96 hours) intracranial hypertension were studied. Parameters recorded included admission age, GCS, evidence of prehospital hypotension, initial computed tomography findings, intracranial pressure (ICP), cerebral perfusion pressure (CPP), and therapeutic intensity level.
Thirty-eight percent of patients in this study achieved a Glasgow Outcome Scale score (GOS) of 4 (moderate disability) or better when assessed 1 year after injury. Patients who achieved these good outcomes were significantly younger (mean 23.6 +/- 8.8 years) than patients who were severely disabled or worse (GOS 1-3) (34.3 +/- 15.0 years) (p = 0.0098). The mean admission GCS in the good-outcome group tended to be higher than that of the poor-outcome group (5.8 +/- 1.5 vs 4.8 +/- 1.6, p = 0.065). When patients with good outcomes (GOS 4 or 5) were compared with those with poor outcomes (GOS 1-3), no significant differences in mean or peak ICP, percentage of time intervals with elevated ICP, lowest recorded CPP, or length of ICP monitoring were detected.
Younger patients, particularly those with GCS > 5, have the potential for excellent recovery despite prolonged (> 96 hours) intracranial hypertension. These patients will benefit from continued aggressive ICP and CPP management.
描述一组事先被认为预后不佳的重型颅脑损伤患者的功能转归，并确定可用于有效家庭咨询和合理利用稀缺资源的预后因素。
研究了37例重型颅脑损伤（入院时格拉斯哥昏迷量表（GCS）评分<8）且颅内高压持续时间延长（>96小时）的患者。记录的参数包括入院年龄、GCS、院前低血压证据、初始计算机断层扫描结果、颅内压（ICP）、脑灌注压（CPP）和治疗强度水平。
在本研究中，38%的患者在受伤1年后评估时格拉斯哥预后量表（GOS）评分为4（中度残疾）或更好。取得这些良好预后的患者比严重残疾或更差（GOS 1-3）的患者明显年轻（平均23.6±8.8岁）（34.3±15.0岁）（p = 0.0098）。良好预后组的平均入院GCS往往高于不良预后组（5.8±1.5对4.8±1.6，p = 0.065）。将良好预后（GOS 4或5）的患者与不良预后（GOS 1-3）的患者进行比较时，未发现平均或峰值ICP、ICP升高的时间间隔百分比、记录到的最低CPP或ICP监测时间长度有显著差异。
年轻患者，尤其是GCS>5的患者，尽管颅内高压持续时间延长（>96小时），仍有实现极佳恢复的潜力。这些患者将受益于持续积极的ICP和CPP管理。
