Department of Neurology, Transitional Learning Center at Galveston, The Moody Center for Traumatic Brain & Spinal Cord Injury Research/Mission Connect, The University of Texas Medical Branch, Galveston, Texas 77550, USA.
J Neurotrauma. 2010 Aug;27(8):1529-40. doi: 10.1089/neu.2010.1358.
Traumatic brain injury (TBI) is seen by the insurance industry and many health care providers as an "event." Once treated and provided with a brief period of rehabilitation, the perception exists that patients with a TBI require little further treatment and face no lasting effects on the central nervous system or other organ systems. In fact, TBI is a chronic disease process, one that fits the World Health Organization definition as having one or more of the following characteristics: it is permanent, caused by non-reversible pathological alterations, requires special training of the patient for rehabilitation, and/or may require a long period of observation, supervision, or care. TBI increases long-term mortality and reduces life expectancy. It is associated with increased incidences of seizures, sleep disorders, neurodegenerative diseases, neuroendocrine dysregulation, and psychiatric diseases, as well as non-neurological disorders such as sexual dysfunction, bladder and bowel incontinence, and systemic metabolic dysregulation that may arise and/or persist for months to years post-injury. The purpose of this article is to encourage the classification of TBI as the beginning of an ongoing, perhaps lifelong process, that impacts multiple organ systems and may be disease causative and accelerative. Our intent is not to discourage patients with TBI or their families and caregivers, but rather to emphasize that TBI should be managed as a chronic disease and defined as such by health care and insurance providers. Furthermore, if the chronic nature of TBI is recognized by government and private funding agencies, research can be directed at discovering therapies that may interrupt the disease processes months or even years after the initiating event.
创伤性脑损伤（TBI）被保险业和许多医疗保健提供者视为“事件”。一旦治疗并提供短暂的康复期，就会存在这样一种观念，即 TBI 患者只需接受很少的进一步治疗，并且不会对中枢神经系统或其他器官系统产生持久影响。事实上，TBI 是一种慢性疾病过程，符合世界卫生组织的定义，即具有以下一个或多个特征：它是永久性的，由不可逆转的病理改变引起，需要对患者进行特殊的康复训练，和/或可能需要长期观察、监督或护理。TBI 会增加长期死亡率并降低预期寿命。它与癫痫发作、睡眠障碍、神经退行性疾病、神经内分泌失调和精神疾病的发生率增加有关，以及非神经疾病，如性功能障碍、膀胱和肠道失禁以及全身代谢失调，这些可能在受伤后数月至数年出现和/或持续存在。本文的目的是鼓励将 TBI 分类为一个持续的、可能是终身的过程的开始，该过程会影响多个器官系统，并且可能是疾病的原因和加速因素。我们的目的不是劝阻 TBI 患者或他们的家人和护理人员，而是强调 TBI 应作为一种慢性病进行管理，并由医疗保健和保险提供者进行定义。此外，如果政府和私人资助机构认识到 TBI 的慢性性质，那么研究可以针对发现可能在起始事件发生数月甚至数年后中断疾病进程的疗法。
