Preliminary study on the time window of early decompressive craniectomy in the treatment of severe traumatic brain injury

doi:10.3877/cma.j.issn.2095-9141.2022.02.006

Abstract

Abstract:

Objective

To investigate the feasibility and reliability of early decompressive craniectomy (EDC) in field hospitals under simulated emergency state.

Methods

A single center retrospective cohort study was conducted in 40 patients with severe and extremely severe traumatic brain injury (sTBI) admitted to the Neurosurgery Department of the 960^th Hospital of Chinese PLA from January 2016 to September 2019. They were divided into EDC group and decompressive craniectomy (DC) group according to the operation time. The operation time window, the amount of intraoperative blood transfusion, brain contusion and laceration progressed to form a hematoma within 24 h after injury, the time window of postoperative cerebral hernia and the stable time window of vital signs after safe evacuation were compared between the two groups.

Results

The operation time of EDC group was shorter than that of DC group, the amount of intraoperative blood transfusion was less than that of DC group, the incidence of progressive cerebral contusion and cerebral hernia within 24 h was less than that of DC group, and the time window of cerebral hernia was longer than that of DC group (P<0.05). There was no significant difference in the stability time of postoperative vital signs between the two groups (P>0.05).

Conclusion

EDC is an effective surgical method for sTBI in field medical station under emergency state.

Key words: Emergency state, Field medical center, Severe traumatic brain injury, Early decompressive craniectomy

Xueming Lyu, Zhenyu Zhao, Chenyu Chu, Xintong Sun, Yongqiang Zhang, Shaoji Yuan, Fulin Lyu. Preliminary study on the time window of early decompressive craniectomy in the treatment of severe traumatic brain injury[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(02): 92-95.

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References 15

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项目		DC组（n=20）	EDC组（n=20）	χ²/t值	P值
性别（男/女）		15/5	17/3	0.625	0.429
年龄（岁，±s）		47.40±12.96	48.05±11.88	-0.165	0.870
致伤原因
	车祸伤	12	13	0.107	0.744
	高处坠落伤	4	5	0.143	0.705
	击打伤	2	1	0.360	0.548
	致伤不明	2	1	0.360	0.548
术前GCS评分（分，±s）		7.35±2.16	7.55±2.46	-0.273	0.786

项目		DC组（n=20）	EDC组（n=20）	χ²/t值	P值
性别（男/女）		15/5	17/3	0.625	0.429
年龄（岁，±s）		47.40±12.96	48.05±11.88	-0.165	0.870
致伤原因
	车祸伤	12	13	0.107	0.744
	高处坠落伤	4	5	0.143	0.705
	击打伤	2	1	0.360	0.548
	致伤不明	2	1	0.360	0.548
术前GCS评分（分，±s）		7.35±2.16	7.55±2.46	-0.273	0.786

组别	例数	手术时间（min，±s）	术中输血量（mL，±s）	24 h内进展性脑挫裂伤[例（%）]	脑疝[例（%）]	伤后出现脑疝时间[h，M(P₂₅,P₇₅)]	术后生命体征稳定时间（h，±s）
EDC	20	72.12±16.00	260.23±50.01	9（45.0）	6（30.0）	18.50（9.00，26.00）	32.21±9.72
DC组	20	96.23±14.05	840.22±60.00	10（50.0）	16（80.0）	0.75（0.50，2.00）	29.12±7.54
χ²/t/U值		5.072	33.21	0.100	10.101	8.000	1.212
P值		<0.001	<0.001	0.752	0.002	0.002	0.233

组别	例数	手术时间（min，±s）	术中输血量（mL，±s）	24 h内进展性脑挫裂伤[例（%）]	脑疝[例（%）]	伤后出现脑疝时间[h，M(P₂₅,P₇₅)]	术后生命体征稳定时间（h，±s）
EDC	20	72.12±16.00	260.23±50.01	9（45.0）	6（30.0）	18.50（9.00，26.00）	32.21±9.72
DC组	20	96.23±14.05	840.22±60.00	10（50.0）	16（80.0）	0.75（0.50，2.00）	29.12±7.54
χ²/t/U值		5.072	33.21	0.100	10.101	8.000	1.212
P值		<0.001	<0.001	0.752	0.002	0.002	0.233

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