去骨瓣减压术在儿童重型颅脑损伤中的应用及研究进展

儿童颅脑损伤是引起儿童创伤死亡和致残的首位危险因素.多数颅脑损伤为轻中度损伤,预后相对良好.重型颅脑损伤(severe TBI,sTBI)是指心肺复苏后格拉斯哥昏迷指数(glasgow coma scale,GCS)评分≤8分的颅脑外伤,常常会导致患儿死亡或残疾.外科常采用去颅瓣减压术(decompressive craniectomy,DC)治疗TBI患儿,通过去除部分颅骨,使脑实质不再受限于骨腔,通过增加脑容积来降低颅内压(intracranial pressure,ICP),从而改善脑灌注压力(cerebral perfusion pressure,CPP),并降低发生大脑中线移位、脑干压缩和脑疝的概率:然而DC通常不是首选策略而是作为辅助治疗手段用于临床.本文就DC的优缺点及其在儿童重症颅脑外伤中的应用和研究进展进行探讨.

Advances of decompressive craniectomy for severe traumatic brain injury in children

Traumatic brain injury has been a leading risk for mortality and disability in children.Most cases are of mild-and-moderate injury.And the remainder is classified as severe.Severe traumatic brain injury (sTBI) often has a Glasgow coma scale of 8 points or under after successful cardiopulmonary resuscitation (CPR).Decompressive craniectomy (DC) is commonly employed for TBI.A partial removal of skull is performed for swollen brain parenchyma to lower intracranial pressure (ICP) and restore cerebral perfusion pressure (CPP).However DC has not been a primary option for sTBI in children.The focus of this review is discussing the merits and demerits of DC and the relevant clinical advances.