Turkish Neurosurgery 2014 , Vol 24 , Num 2
Effect of Gradient Decompression on the Occurrence of Intraoperative Hypotension and Prognosis in Traumatic Brain Injury
Xu MIN1, Wang CUN-ZU2, Wang YUN-HUAN3, Lu XIAO -FENG1, Bao QING1, Xie ZHENG-XING4, Zhuang YAN4, Chang ZHI-YING5, Wu MIN4, Chen ZE-JUN4
1Jiangsu University, Clinical Medicine College, Zhenjiang Jiangsu, China
2Yangzhou Jiangsu, Wound Institute of Jiangsu University, Northern Jiangsu People’s Hospital, Department of Neurosurgery, Zhenjiang Jiangsu, China
3Jintan TCM Hospital, Department of Anesthesiology, Changzhou Jiangsu, China
4The Affiliated Hospital of Jiangsu University, Department of Neurosurgery, Zhenjiang Jiangsu, China
5The Affiliated Hospital of Jiangsu University, Department of Medical Record Library, Zhenjiang Jiangsu, China
DOI : 10.5137/1019-5149.JTN.8154-13.1 AIM: To investigate the effect of gradient decompression on the occurrence of intraoperative hypotension and prognosis in traumatic brain injury.

MATERIAL and METHODS: A retrospective analysis was performed in 186 hospitalized patients from January, 2008 to January, 2012 in the Affiliated Hospital of Jiangsu University. Demographic data, the abnormality of pupils, and Glasgow Coma Scale (GCS) before operation, and gradient decompression measures, and intraoperative hypotension during operation, and mortality after operation were recorded. Gradient decompression measures were mannitol, hyperventilation, graded craniotomy, and Chi-square test was conducted to evaluate the association of gradient decompression with intraoperative hypotension and prognosis.

RESULTS: All the gradient decompression measures were shown non-significantly associated with the occurrence of intraoperative hypotension and prognosis, including mannitol (p=0.852, p=0.328), hyperventilation (p=0.484, p=0.619) and graded craniotomy (p=0.326, p=0.605). Mannitol with hyperventilation (p=0.733, p=0.758), mannitol with graded craniotomy (p=0.319, p=1.000), hyperventilation with graded craniotomy (p=0.269, p=0.685) and all the three measures (p=0.135, p=0.589) were also non-significantly associated with the occurrence of intraoperative hypotension and prognosis. The abnormality of pupils (p=0.006), GCS (p﹤0.001) and hypotension (p=0.006) were closely associated with the prognosis.

CONCLUSION: Gradient decompression is not effective in avoiding the occurrence of intraoperative hypotension and improving the prognosis. It provides a new insight into clinical measures for curing patients with severe traumatic brain injury (sTBI). Keywords : Traumatic brain injury, Gradient decompression, Ţntraoperative hypotension, Prognosis

Corresponding author : Wang Cun-zu, wangcunzu@ujs.edu.cn