去骨瓣减压术与外伤性脑损伤康复后10年的生活质量相关

去骨瓣减压术与外伤性脑损伤康复后10年的生活质量相关。

Rauen K等，Crit Care Med，2020年8月

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摘要


目的外伤性脑损伤是儿童和青年人的头号死因，在老年人中发病率越来越高。去骨瓣减压术可预防颅内高压，但不能明显改善外伤后六个月的身体状况。然而，目前还没有分析去骨瓣减压术是否会长期影响创伤性脑损伤患者的生活质量。

设计因此，我们进行了一项横断面研究，评估外伤后10年内有或无颅骨减压手术的创伤性脑损伤患者的健康相关生活质量。

设置前危重病人。

慢性创伤性脑损伤患者在急性治疗期间没有（n=37）或接受过（n=98）去骨瓣减压术。

测量和主要结果：在所有初始创伤性脑损伤严重程度组中，均需进行去骨瓣减压术。与脑外伤后10年内未进行头骨瓣减压术的患者相比，有8%的患者报告了良好的健康相关生活质量，且脑损伤后生活质量总分大于或等于60（p=0.004）。最初，轻度创伤性脑损伤患者在脑损伤后的生活质量中位数为83分（去骨瓣减压术）和62分（不进行颅骨瓣减压术）（p=0.028）。与身体状况相关的健康相关生活质量在去骨瓣减压术患者中更好（p=0.025）。在61-85岁的人群中，去骨瓣减压术显示出更好的健康相关生活质量的趋势，这反映在脑损伤后的生活质量中位数为62分（不进行减压术）和79分（去骨瓣减压术）（p=0.06）。

结论我们的研究结果表明，去骨瓣减压术与脑外伤后10年内良好的健康相关生活质量相关。因此，去骨瓣减压术可能低估了创伤性脑损伤后的治疗潜力。

Decompressive Craniectomy Is Associated With Good Quality of Life Up to 10 Years After Rehabilitation From Traumatic Brain Injury.
Rauen K,et al Crit Care Med 2020 Aug
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Abstract 翻译

OBJECTIVES Traumatic brain injury is the number one cause of death in children and young adults and has become increasingly prevalent in the elderly. Decompressive craniectomy prevents intracranial hypertension but does not clearly improve physical outcome 6 months after traumatic brain injury. However, it has not been analyzed if decompressive craniectomy affects traumatic brain injury patients' quality of life in the long term.
DESIGN Therefore, we conducted a cross-sectional study assessing health-related quality of life in traumatic brain injury patients with or without decompressive craniectomy up to 10 years after injury.
SETTING Former critical care patients.
PATIENTS Chronic traumatic brain injury patients having not (n = 37) or having received (n = 98) decompressive craniectomy during the acute treatment.
MEASUREMENTS AND MAIN RESULTS Decompressive craniectomy was necessary in all initial traumatic brain injury severity groups. Eight percent more decompressive craniectomy patients reported good health-related quality of life with a Quality of Life after Brain Injury total score greater than or equal to 60 compared with the no decompressive craniectomy patients up to 10 years after traumatic brain injury (p = 0.004). Initially, mild classified traumatic brain injury patients had a median Quality of Life after Brain Injury total score of 83 (decompressive craniectomy) versus 62 (no decompressive craniectomy) (p = 0.028). Health-related quality of life regarding physical status was better in decompressive craniectomy patients (p = 0.025). Decompressive craniectomy showed a trend toward better health-related quality of life in the 61-85-year-old reflected by median Quality of Life after Brain Injury total scores of 62 (no decompressive craniectomy) versus 79 (decompressive craniectomy) (p = 0.06).
CONCLUSIONS Our results suggest that decompressive craniectomy is associated with good health-related quality of life up to 10 years after traumatic brain injury. Thus, decompressive craniectomy may have an underestimated therapeutic potential after traumatic brain injury.