Tang Mary E, Lobel Darlene A
Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA.
Mt Sinai J Med. 2009 Apr;76(2):119-28. doi: 10.1002/msj.20106.
Severe traumatic brain injury is one of the leading causes of death and disability in the United States. The initial management of traumatic brain injury involves early resuscitation, computed tomography scanning, and surgical evacuation of mass lesions, when indicated. Recent research suggests that the prevention and treatment of secondary brain injury decrease mortality and improve outcomes. Specifically, treatment should address not only cerebral protection but also prevention of injury to other organ systems. To achieve the best outcomes, attention must be focused on optimizing blood pressure and brain tissue oxygenation, maintaining adequate cerebral perfusion pressures, and preventing seizures. In addition, maximizing good outcomes depends on proactively addressing the risk of common sequelae of brain injury, including infection, deep venous thrombosis, and inadequate nutrition. Guidelines developed for the management of severe traumatic brain injury have dramatically improved functional neurological outcomes.
严重创伤性脑损伤是美国死亡和残疾的主要原因之一。创伤性脑损伤的初始治疗包括早期复苏、计算机断层扫描，以及在有指征时对占位性病变进行手术清除。最近的研究表明，继发性脑损伤的预防和治疗可降低死亡率并改善预后。具体而言，治疗不仅应关注脑保护，还应预防对其他器官系统的损伤。为实现最佳预后，必须注重优化血压和脑组织氧合、维持足够的脑灌注压以及预防癫痫发作。此外，最大限度地提高良好预后取决于积极应对脑损伤常见后遗症的风险，包括感染、深静脉血栓形成和营养不足。为严重创伤性脑损伤管理制定的指南已显著改善了神经功能预后。
