Mulvey Jamin M, Dorsch Nicholas W C, Mudaliar Yugan, Lang Erhard W
Department of Intensive Care, University of Sydney, Westmead Hospital, Westmead Australia.
Neurocrit Care. 2004;1(3):391-402. doi: 10.1385/NCC:1:3:391.
Traumatic brain injury (TBI) is a major cause of morbidity and mortality with widespread social, personal, and financial implications for those who survive. TBI is caused by four main events: motor vehicle accidents, sporting injuries, falls, and assaults. Similarly to international statistics, annual incidence reports for TBI in Australia are between 100 and 288 per 100,000. Regardless of the cause of TBI, molecular and cellular derangements occur that can lead to neuronal cell death. Axonal transport disruption, ionic disruption, reduced energy formation, glutamate excitotoxicity, and free radical formation all contribute to the complex pathophysiological process of TBI-related neuronal death. Targeted pharmacological therapy has not proved beneficial in improving patient outcome, and monitoring and maintenance of various physiological parameters is the mainstay of current therapy. Parameters monitored include arterial blood pressure, blood gases, intracranial pressure, cerebral perfusion pressure, cerebral blood flow, and direct brain tissue oxygen measurement (ptiO2). Currently, indirect brain oximetry is used for cerebral oxygenation determination, which provides some information regarding global oxygenation levels. A newly developed oximetry technique, has shown promising results for the early detection of cerebral ischemia. ptiO2 monitoring provides a safe, easy, and sensitive method of regional brain oximetry, providing a greater understanding of neurophysiological derangements and the potential for correcting abnormal oxygenation earlier, thus improving patient outcome. This article reviews the current status of bedside monitoring for patients with TBI and considers whether ptiO2 has a role in the modern intensive care setting.
创伤性脑损伤（TBI）是发病和死亡的主要原因，对幸存者有着广泛的社会、个人和经济影响。TBI由四个主要事件引起：机动车事故、运动损伤、跌倒和袭击。与国际统计数据类似，澳大利亚TBI的年发病率报告为每10万人中有100至288例。无论TBI的病因如何，都会发生分子和细胞紊乱，进而导致神经元细胞死亡。轴突运输中断、离子紊乱、能量生成减少、谷氨酸兴奋性毒性和自由基形成均促成了TBI相关神经元死亡的复杂病理生理过程。靶向药物治疗尚未证明对改善患者预后有益，监测和维持各种生理参数是当前治疗的主要手段。监测的参数包括动脉血压、血气、颅内压、脑灌注压、脑血流量以及直接脑组织氧测量（ptiO2）。目前，间接脑血氧测定法用于确定脑氧合，它能提供一些关于整体氧合水平的信息。一种新开发的血氧测定技术在早期检测脑缺血方面已显示出有前景的结果。ptiO2监测提供了一种安全、简便且灵敏的局部脑血氧测定方法，能更深入了解神经生理紊乱情况以及更早纠正异常氧合的可能性，从而改善患者预后。本文综述了TBI患者床边监测的现状，并探讨ptiO2在现代重症监护环境中是否具有作用。
