控制减压技术对外伤性急性弥漫性脑肿胀患者预后的影响——一项回顾性队列研究OA

Objective To investigate the effect of controlled decompressive technique on the prognosis of patients with posttraumatic acute diffuse brain swelling(PADBS).Methods A retrospective cohort study was conducted to analyze the clinical,imaging,and intracranial pressure(ICP)monitoring data of 353 PADBS patients admitted to 904 Hospital of PLA Logistics Joint Support Force from January 2015 to July 2025.The prognosis was assessed using the Glasgow outcome scale-extended(GOSE),with a score of 5-8 indicating a favorable outcome.Results A total of 353 PADBS patients were enrolled and divided into a controlled decompression group and a non-controlled decompression group based on whether controlled decompression techniques were employed during surgery.The controlled decompression group comprised 213 cases,among which 122 were equipped with tissue-type ICP monitoring and 91 with ventricular-type ICP monitoring,preoperative GCS scores ranged from 3-8 in 162 cases,9-12 in 51 cases,and 124 cases presented with brain herniation.The non-controlled decompression group included 140 cases,with 29 cases receiving tissue-type ICP monitoring,29 cases with ventricular-type ICP monitoring,and 82 cases without ICP monitoring,preoperative GCS scores ranged from 3-8 in 107 cases,9-12 in 33 cases,and 76 cases exhibited brain herniation.At a follow-up of over 6 months,the controlled decompression group demonstrated a favorable prognosis rate of 56.3%,significantly higher than the non-controlled decompression group(38.6%,P=0.001).However,the 30-day all-cause mortality rate was 7.5%in the controlled decompression group,which was markedly lower than the non-controlled decompression group(12.1%),though the difference was not statistically significant(P>0.05).Univariate analysis of both groups revealed that,compared to the non-controlled decompression group,the controlled decompression group had significantly higher proportions of patients aged<60 years,generalized cerebral edema,emergency surgery,decompressive craniectomy,tissue-type ICP,and ventricular-type ICP(P<0.05).Adjusted for age,type of cerebral edema,emergency surgery,decompressive craniectomy,and ICP type,modified Poisson regression model demonstrated that controlled decompression significantly improved patient outcomes compared to non-controlled decompression(RR=1.953,95%CI=1.438-2.654,P<0.001).Conclusions The controlled decompression technique can effectively improve the prognosis of PADBS patients.