Acute Management of Traumatic Brain Injury.
Acute Management of Traumatic Brain Injury.
复制标题
DOI：
10.1016/j.suc.2017.06.003
复制
发表时间：
2017-10
期刊：
影响因子：
--
通讯作者：
Patel MB
中科院分区：
文献类型：
--
作者：
Vella MA;Crandall ML;Patel MB
创伤性脑损伤（TBI）是创伤患者死亡和残疾的主要原因。由于原发性损伤无法消除，因此管理策略必须侧重于通过避免低血压和缺氧以及维持适当的脑灌注压（CPP）（脑血流量（CBF）的替代品）来预防继发性损伤。脑灌注压可以通过增加平均动脉压（MAP）、降低颅内压（ICP）或两者来维持。在正常血容量状态下，通过联合使用升压药可以增加MAP，尽管TBI患者的理想液体尚不清楚。目标应该是血容量正常和避免低血压。颅内压升高可通过算法方法治疗，在难治性病例中使用简单的床边操作、高渗治疗、脑脊液（CSF）引流以及戊巴比妥昏迷和去骨瓣减压术。根据肿块的大小、检查结果和ICP测量结果，可能需要手术清除。虽然CPP可能不是脑血流和代谢输送的理想替代品，但由于缺乏有力的数据，其他方式尚未得到广泛使用。在TBI患者的急性管理中值得重要考虑的其他因素是静脉血栓栓塞、应激性溃疡和癫痫预防以及营养和代谢优化。
Traumatic brain injury (TBI) is a leading cause of death and disability in trauma patients. As the primary injury cannot be undone, management strategies must therefore focus on preventing secondary injury by avoiding hypotension and hypoxia and maintaining appropriate cerebral perfusion pressure (CPP), which is a surrogate for cerebral blood flow (CBF). Cerebral perfusion pressure can be maintained by increasing mean arterial pressure (MAP), decreasing intracranial pressure (ICP), or both. MAP can be increased through a combination of pressors in the euvolemic state, although the ideal fluid in TBI patients is unknown. The goal should be euvolemia and avoidance of hypotension. Elevated intracranial pressure can be treated through an algorithmic approach utilization simple bedside maneuvers, hyperosmolar therapy, cerebral spinal fluid (CSF) drainage as well as pentobarbital coma and decompressive craniectomy in refractory cases. Mass lesions may require operative evacuation depending on size, exam findings, and ICP measurements. Although CPP may not be an ideal surrogate for cerebral blood flow and metabolic delivery, other modalities have not gained widespread use due to paucity of strong data. Other factors that deserve important consideration in the acute management of TBI patients are venous thromboembolism, stress ulcer, and seizure prophylaxis as well as nutritional and metabolic optimization.
登录
查看更多内容
DOI：
10.1136/bmj.d3795
发表时间：
2011-07-01
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
CRASH-2 Collaborators, Intracranial Bleeding Study
通讯作者：
CRASH-2 Collaborators, Intracranial Bleeding Study
影响因子：
4.1
作者：
Farahvar, Arash;Gerber, Linda M.;Ghajar, Jamshid
通讯作者：
Ghajar, Jamshid
影响因子：
4.8
作者：
Carney, Nancy;Totten, Annette M.;Ghajar, Jamshid
通讯作者：
Ghajar, Jamshid
影响因子：
2.5
作者：
Dewan Y;Komolafe EO;Mejía-Mantilla JH;Perel P;Roberts I;Shakur H;CRASH-3 Collaborators
通讯作者：
CRASH-3 Collaborators
影响因子：
3.5
作者：
Bilotta, Federico;Caramia, Remo;Rosa, Giovanni
通讯作者：
Rosa, Giovanni