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Journals / Ulusal Travma ve Acil Cerrahi Dergisi / 2012 / Cilt: 18 - Sayı: 3

Ağır travmatik beyin yaralanması ve bilateral reaktif olmayan pupil dilatasyonu bulunan hastalarda dekompresif cerrahinin etkileri

Effects of decompressive surgery in patients with severe traumatic brain injury and bilateral non-reactive dilated pupils

Ethem GÖKSU
Tanju UÇAR
Mahmut AKYÜZ
MURAT YILMAZ
MEHMET SAİM KAZAN
Pages
231–238
DOI
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AI Summary & Key Takeaways

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⚡ TL;DR(Too Long; Didn't Read)

The overall mortality rate was 61.02%.

📌 3 Key Takeaways

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Objective & Hypothesis:BACKGROUND We investigated Glasgow Coma Scale (GCS) scores, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) changes, and long-term clinical outcomes in patients with severe traumatic brain injury (STBI) associated with bilateral non-reactive dilated pupils (BNDP) who underwent decompressive surgery (DS).
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Key Findings & Data:METHODS The study group consisted of 28 patients (11 females, 17 males) with BNDP from among 147 patients who underwent DS due to STBI in our department.
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Conclusion & Impact:The overall mortality rate was 61.02%.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Domain Parameters

Abstract

BACKGROUND We investigated Glasgow Coma Scale (GCS) scores, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) changes, and long-term clinical outcomes in patients with severe traumatic brain injury (STBI) associated with bilateral non-reactive dilated pupils (BNDP) who underwent decompressive surgery (DS). METHODS The study group consisted of 28 patients (11 females, 17 males) with BNDP from among 147 patients who underwent DS due to STBI in our department. RESULTS The mean GCS score was 4.96±1.20 at admission and 4 preoperatively. Mean ICP in non-surviving patients after DS was higher (p<0.05). ICP decrease after DS was also higher in surviving patients than in non-surviving patients (p<0.05). The overall mortality rate was 61.02%. A GCS motor score >2 at admission was associated with lower mortality (p<0.05). Four of the surviving patients (14.28%) had a functional outcome (Glasgow Outcome Score: 4 and 5) at one year after hospital discharge. CONCLUSION Outcome in patients with BNDP after STBI may not always be fatal or poor. Rapid DS may increase the chance of functional survival, especially in patients with admission GCS score of 6 or 7.

Özet

AMAÇ Ağır travmatik beyin yaralanmalı (ATBY) ve bilateral reaktif olmayan pupil dilatasyonu (BRPD) olup, dekompresif cerrahi (DC) uygulanmış hastalarda Glasgow koma skalası (GKS), kafa içi basınç (KİB), serebral perfüzyon basıncı (SPP) değişiklikleri ve uzun dönem klinik sonuçları değerlendirildi. GEREÇ VE YÖNTEM Çalışma gurubu, bölümümüzde ATBY nedeniyle DC uygulanan 147 hasta içerisinden BRPD’li 28 hastayı (11 kadın, 17 erkek) içerdi. BULGULAR Ortalama GKS skoru, başvuruda 4,96±1,20, ameliyat öncesi dönemde 4 idi. Ölen hastalarda, DC sonrası ortalama KİB değerleri hayatta kalanlara göre anlamlı ölçüde yüksekti (p<0,05). Ayrıca, DC sonrası KİB azalması, yaşayan hastalarda yine anlamlı olarak yüksekti (p<0,05). Tümden mortalite oranı %61,02 bulundu. Başvuruda ikinin üzeri GKS motor skoru anlamlı olarak düşük mortalite ile ilişkili idi (p<0,05). Yaşayan 4 hasta taburcu sonrası birinci yılda (%14,28) işlevsel sonuç skoru (Glasgow sonuç skoru 4 ve 5) gösterdi. SONUÇ ATBY sonrası BRPD’li hastalarda sonuçlar her zaman ölümcül ya da olumsuz olmayabilir. Hızlı DC, özellikle başvuru GKS skoru 6, 7 olan hastalarda işlevsel sağkalım şansını artırabilir.

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Cite This Article

GÖKSU, E., UÇAR, T., AKYÜZ, M., YILMAZ, M., KAZAN, M. S. (2012). Ağır travmatik beyin yaralanması ve bilateral reaktif olmayan pupil dilatasyonu bulunan hastalarda dekompresif cerrahinin etkileri. Ulusal Travma ve Acil Cerrahi Dergisi, Cilt: 18 - Sayı: 3, 231–238. https://ajindex.com/articles/324165

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