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在超严重的关闭创伤性脑损伤中进行神经外科干预:这是值得的吗?

Nikolaos Gkantsinikoudis¹, Iftakher Hossain^2,3, Niklas Marklund⁴

¹Department of Neurosurgery, Hippokration General Hospital, Aristotle University School of Medicine, Thessaloniki, Greece.

|September 12, 2024

概括

超严重的创伤性脑损伤 (US-TBI) 患者往往有糟糕的结果. 早期的神经外科干预可能会改善某些美国TBI患者的结果,但需要更多的数据来个性化治疗决策.

科学领域:

神经外科神经外科
创伤外科手术创伤外科
关键护理医学关键护理医学

背景情况:

超严重的创伤性脑损伤 (US-TBI),以3-5的复苏后格拉斯哥昏迷度量表 (GCS) 定义, presents一个管理挑战.
神经外科干预对美国TBI患者的潜在益处仍然不确定.

研究的目的:

批判性地审查有关美国TBI患者决策和结果的现有证据.
评估神经外科干预对美国人死亡率和功能结果的影响-TBI.

主要方法:

从1979年到2024年5月,在主要数据库 (PubMed,Google Scholar,Scopus,Cochrane Library) 中进行了全面的文献搜索.
纳入标准侧重于成年患者 (>18岁) 关闭头部创伤和入院GCS为3-5,包括治疗策略,死亡率和功能结果的数据.

主要成果:

美国TBI患者的死亡率在27-100%之间,只有4-30%的患者观察到有利的功能结果.
早期,积极的神经外科管理与死亡率的降低有关,尽管很大一部分幸存者经历了不利的功能状态.

结论:

仅仅是支持性护理对我们-TBI患者来说,就产生了普遍糟糕的结果.
美国选择的TBI患者,特别是GCS>3和质病变的年轻人,可能会从早期的,积极的神经外科干预以及最佳的医疗管理中受益.
没有足够的数据来确定神经外科管理的有效性;治疗决策应该是个性化的.

关键词:

昏迷的昏迷,一个昏迷的昏迷.压缩减压的方法固定的学生固定的学生格拉斯哥昏迷表 3-5 3-5 格拉斯哥昏迷表结果结果的结果.创伤性脑损伤是一种创伤性脑损伤.治疗方法治疗方法超严重超严重非常严重非常严重

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