双侧去骨瓣减压术对重度创伤性脑损伤患者预后的影响

Effect of Bilateral Decompressive Craniectomy on Prognosis of Patients with Severe Traumatic Brain Injury

摘要: 背景：在这项研究中，我们回顾性研究了双侧去骨瓣减压术(Bilateral decompressive craniectomy, BDC)在治疗重度创伤性脑损伤(Traumatic brain injury, TBI)后弥漫性脑肿胀患者的结果。方法：我们收集了2006年9月至2019年5月期间3151名入院接受治疗的重度TBI患者的数据，共确定了33名患者，并评估了他们创伤后6个月的GOS评分。结果：15名患者(45.45%)预后尚可(GOS，4~5)，其中包括9名患者(27.27%)中度功能缺陷，6名患者(18.18%)恢复良好。有14名患者(42.42%)预后不良(GOS，2~3)，包括3名植物状态(9.09%)和11名重度功能缺陷(33.33%)。4名患者死亡(12.12%)，其中2人死于难以控制的颅内压增高，1人死于多器官衰竭，1人死于严重感染。重度TBI患者BDC术后最常见的并发症是硬膜下积液(7例，21.21%)，一般发生在术后10~16天。3名患者(9.09%)出现迟发性颅内血肿。2名(6.06%)患者出现脑积水(一名发生在术后1.5个月，另一名在术后2个月)并接受了V-P分流手术。3例患者发生外伤后癫痫(9.09%)。我们的病例中没有颅内感染和脑脊液漏。结论：使用BDC是一种快速有效的方法，可以降低恶性弥漫性脑肿胀引起的难治性颅内压(Intracranial Pressure, ICP)增高，改善预后。手术时机是影响预后的重要因素，因此应尽早进行手术。

Abstract: Background: In this study, we retrospectively analyzed the outcome of bilateral decompressive cra-niectomy in the management of patients with malignant diffuse brain swelling after severe trau-matic brain injury from a single neurotrauma center. Methods: We collected data from 33 patients during the time period from September, 2006 to May, 2019. A total of 3151 patients who were ad-mitted into our departments and treated for TBI were identified. Six months after trauma, the GOS scores were evaluated. Results: Favorable outcomes (GOS, 4~5) occurred in 15 patients (45.45%), including 9 patients (27.27%) with moderate deficits and 6 patients (18.18%) with good recovery. However, unfavorable outcomes (GOS, 2~3) were observed in 14 patients (42.42%), including 3 pa-tients (9.09%) with a vegetative state and 11 patients (33.33%) with severe deficits. Four patients died (12.12%), of which 2 died from uncontrolled ICP, 1 died from multiple organ failure, and 1 died severe infection. The most common complications of severe TBI after BDC were subdural effusion (7 patients, 21.21%) which occurred during 10~16 days after surgery and these patients received lumbar cerebrospinal fluid drainage. Three patients (9.09%) developed a delayed intracranial he-matoma. Two (6.06%) patients developed hydrocephalus (one happened 1.5 months post-operation; the other one was diagnosed 2 months post-operation) and received a V-P shunt. Post-traumatic ep-ilepsy occurred in three patients (9.09%). There was no intracranial infection and CSF fistula in our cases. Conclusions: It is a fast and effective method to reduce ICP and improve the prognosis caused by refractory diffuse brain swelling by using BDC. Timing of surgery is a significant factor affecting the prognosis, so it should be performed as early as possible.