Walker Peter A, Harting Matthew T, Baumgartner James E, Fletcher Stephen, Strobel Nathan, Cox Charles S
Department of Pediatric Surgery, University of Texas Medical School at Houston, Texas 77030, USA.
J Trauma. 2009 Aug;67(2 Suppl):S120-7. doi: 10.1097/TA.0b013e3181ad323a.
Each year, pediatric traumatic brain injury (TBI) accounts for 435,000 emergency department visits, 37,000 hospital admissions, and approximately 2,500 deaths in the United States. TBI results in immediate injury from direct mechanical force and shear. Secondary injury results from the release of biochemical or inflammatory factors that alter the loco-regional milieu in the acute, subacute, and delayed intervals after a mechanical insult. Preliminary preclinical and clinical research is underway to evaluate the benefit from progenitor cell therapeutics, hypertonic saline infusion, and controlled hypothermia. However, all phase III clinical trials investigating pharmacologic monotherapy for TBI have shown no benefit. A recent National Institutes of Health consensus statement recommends research into multimodality treatments for TBI. This article will review the complex pathophysiology of TBI as well as the possible therapeutic mechanisms of progenitor cell transplantation, hypertonic saline infusion, and controlled hypothermia for possible utilization in multimodality clinical trials.
在美国，每年有43.5万名儿童因创伤性脑损伤（TBI）前往急诊科就诊，3.7万人住院，约2500人死亡。TBI会因直接机械力和剪切力导致即时损伤。继发性损伤则是由生化或炎症因子的释放引起的，这些因子会在机械性损伤后的急性、亚急性和延迟期改变局部区域环境。目前正在进行初步的临床前和临床研究，以评估祖细胞疗法、高渗盐水输注和控制性低温的益处。然而，所有针对TBI的药物单一疗法的III期临床试验均未显示出益处。美国国立卫生研究院最近的一份共识声明建议对TBI的多模式治疗进行研究。本文将综述TBI复杂的病理生理学，以及祖细胞移植、高渗盐水输注和控制性低温在多模式临床试验中可能的治疗机制。
