Aryan Rafieezadeh, Kartik Prabhakaran, Amirhossein Sadeghian, Anna Mary Jose, Bardiya Zangbar
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引用次数: 0
摘要
创伤性脑损伤(TBI)在各个地区都会造成严重的死亡率和发病率,给社会造成巨大的社会经济负担。可能出现的一个主要并发症是颅内压(ICP)失控。有几种策略可以降低创伤性脑损伤患者的 ICP,包括抬高头部、给予甘露醇和过度通气。减压开颅术(DC)是一种用于降低 ICP 的治疗方法。该技术可立即、永久地缓解 ICP 升高,但关于其对 ICP 增高患者的有益用途和适当适应症仍存在争议。本综述旨在评估与 DC 相关的手术技术、手术时机和患者特征的变化。通过评估有关 ICP 增高患者 DC 的临床和放射学数据,我们发现,虽然 DC 有诸多益处,但也有很大的死亡率和发病率风险。此外,我们还观察到,年龄、初始格拉斯哥昏迷量表(GCS)评分、瞳孔反应以及损伤与 DC 之间的时间间隔等因素可作为手术结果的预测因素。基于我们的研究结果,我们建议开展进一步的试验,以阐明如何在创伤性脑损伤患者中使用 DC。
Optimizing Traumatic Brain Injury Recovery: Exploring the Advantages and Results of Decompressive Craniectomy.
Traumatic brain injury (TBI) causes significant mortality and morbidity across regions, imposing a substantial socioeconomic burden on societies. A major complication that can arise is uncontrolled intracranial pressure (ICP). Several strategies exist for reducing ICP in TBI patients, including head elevation, mannitol administration, and hyperventilation. Decompressive craniectomy (DC) is a therapeutic approach employed to lower ICP. This technique offers immediate and permanent relief from elevated ICP, although there are ongoing debates regarding its beneficial use and appropriate indications for patients with increased ICP. The objective of this review was to assess variations in surgical technique, timing of the procedure, and patient characteristics associated with DC. Through the evaluation of clinical and radiologic data concerning DC in patients with elevated ICP, it was revealed that while DC provides numerous benefits, it also carries a significant risk of mortality and morbidity. Furthermore, we observed that factors such as age, initial Glasgow Coma Scale (GCS) score, pupil response, and the time interval between injury and DC can serve as predictors for the procedure's outcomes. Based on our findings, we recommend conducting further trials to shed light on the use of DC in TBI patients.