Severe traumatic brain injury: targeted management in the intensive care unit
Severe traumatic brain injury: targeted management in the intensive care unit
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DOI：
10.1016/s1474-4422(17)30118-7
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发表时间：
2017-06-01
期刊：
影响因子：
48
通讯作者：
Menon, David K.
中科院分区：
文献类型：
--
作者：
Stocchetti, Nino;Carbonara, Marco;Menon, David K.
严重创伤性脑损伤（TBI）目前在重症监护室采用内外科联合治疗。治疗的目的是防止额外的脑损伤，并优化脑恢复的条件。TBI通常被认为是一种病理实体并被治疗，尽管事实上它是一种综合征，包括一系列可能需要不同治疗和生理目标的病变。由于监测和成像技术的进步，现在有可能确定脑损伤的具体机制，并更好地针对个人或患者子集进行治疗。靶向治疗对于老年人尤其重要，因为老年人在TBI患者中所占比例越来越大，因为损伤前合并症及其治疗需要量身定制的管理策略。在监测和理解TBI的病理生理机制方面取得的进展可能会改变重症监护室的当前管理，从而实现最终改善结果的有针对性的干预措施。
Severe traumatic brain injury (TBI) is currently managed in the intensive care unit with a combined medical-surgical approach. Treatment aims to prevent additional brain damage and to optimise conditions for brain recovery. TBI is typically considered and treated as one pathological entity, although in fact it is a syndrome comprising a range of lesions that can require different therapies and physiological goals. Owing to advances in monitoring and imaging, there is now the potential to identify specific mechanisms of brain damage and to better target treatment to individuals or subsets of patients. Targeted treatment is especially relevant for elderly people-who now represent an increasing proportion of patients with TBI-as preinjury comorbidities and their therapies demand tailored management strategies. Progress in monitoring and in understanding pathophysiological mechanisms of TBI could change current management in the intensive care unit, enabling targeted interventions that could ultimately improve outcomes.