去骨瓣减压术在儿童重型颅脑损伤中的应用及研究进展

Advances of decompressive craniectomy for severe traumatic brain injury in children

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（glasgowcomascale，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。

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） of ten 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.