Perioperative management of traumatic brain injury.
Perioperative management of traumatic brain injury.
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DOI：
10.4103/2229-5151.79279
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发表时间：
2011-01-01
影响因子：
--
通讯作者：
Sharma, Deepak
中科院分区：
文献类型：
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作者：
Curry, Parichat;Viernes, Darwin;Sharma, Deepak
创伤性脑损伤（TBI）是一个重大的公共卫生问题，也是全世界死亡和残疾的主要原因。尽管有现代的诊断和治疗，TBI患者的预后仍然很差。虽然原发性损伤的严重程度是决定预后的主要因素，但在初次损伤发生后，随着时间的推移，低血压、低氧血症、高碳血症、低碳血症、高血糖和低血糖等生理损伤引起的继发性损伤会进一步损害脑组织，使TBI的预后恶化。围手术期在TBI治疗过程中尤为重要。虽然手术和麻醉可能使患者容易发生新的继发性损伤，这可能对结果产生不利影响，但围手术期也是发现和纠正未确诊的先前存在的继发性损伤的机会，以防止新的继发性损伤，并且是启动可能改善TBI结果的干预措施的潜在窗口。在本综述中，我们对TBI围手术期管理的各个方面进行了广泛的Pubmed和Medline搜索，然后对术中和围手术期的研究进行了回顾。虽然专门针对术中和围术期即时TBI管理的研究有限，但临床管理仍然主要基于生理优化和脑外伤基金会指南的建议。这篇综述的重点是TBI的围手术期管理，特别强调了最近的发展。
Traumatic brain injury (TBI) is a major public health problem and the leading cause of death and disability worldwide. Despite the modern diagnosis and treatment, the prognosis for patients with TBI remains poor. While severity of primary injury is the major factor determining the outcomes, the secondary injury caused by physiological insults such as hypotension, hypoxemia, hypercarbia, hypocarbia, hyperglycemia and hypoglycemia, etc. that develop over time after the onset of the initial injury, causes further damage to brain tissue, worsening the outcome in TBI. Perioperative period may be particularly important in the course of TBI management. While surgery and anesthesia may predispose the patients to new onset secondary injuries which may contribute adversely to outcomes, the perioperative period is also an opportunity to detect and correct the undiagnosed pre-existing secondary insults, to prevent against new secondary insults and is a potential window to initiate interventions that may improve outcome of TBI. For this review, extensive Pubmed and Medline search on various aspects of perioperative management of TBI was performed, followed by review of research focusing on intraoperative and perioperative period. While the research focusing specifically on the intraoperative and immediate perioperative TBI management is limited, clinical management continues to be based largely on physiological optimization and recommendations of Brain Trauma Foundation guidelines. This review is focused on the perioperative management of TBI, with particular emphasis on recent developments.