Honnart D, Defrance N, Noirot M T, Freysz M, Wilkening M
Réanimation Chirurgicale et Traumatologique, Hôpital Général, Centre Hospitalier Régional et Universitaire, Dijon.
Agressologie. 1991;32(1):77-9.
Severe head injury (Glasgow Coma Score less than or equal to 7) is associated with high mortality and morbidity which can be improved by early energetic therapy. Such patients must be picked up by prehospital/EMS service with three aims: controlling ventilation, controlling haemodynamics, avoiding any increased intracranial pressure. After initial neurological assessment, management involves endotracheal intubation, mechanical ventilation following benzodiazepine sedation, early compensation of hypovolemia avoiding any overloading, analgesia for painful injuries; according to the clinical status other pharmacological agents can be used. At admission to emergency unit, intensive care must be continued while X-rays and CT-scan are achieved. Imperative indications of transport to neuro-intensive care unit are discussed for hospitals without a neuro-surgeon.
重型颅脑损伤（格拉斯哥昏迷评分小于或等于7分）与高死亡率和高发病率相关，早期积极治疗可改善这些情况。此类患者必须由院前急救/紧急医疗服务机构接诊，目标有三个：控制通气、控制血流动力学、避免颅内压升高。在进行初步神经学评估后，处理措施包括气管插管、给予苯二氮䓬类镇静剂后进行机械通气、早期纠正低血容量避免任何容量过载、对疼痛性损伤进行镇痛；根据临床情况可使用其他药物。进入急诊室后，在进行X线检查和CT扫描时必须继续进行重症监护。对于没有神经外科医生的医院，讨论了转至神经重症监护病房的必要指征。
