Department of Anesthesiology and Intensive Care Medicine, Charité - University Medicine Berlin, Germany.
Curr Opin Anaesthesiol. 2011 Apr;24(2):144-53. doi: 10.1097/ACO.0b013e328344587f.
Traumatic brain injury is the leading cause of death in young patients and stroke is the leading cause of major disability in elderly patients. Both injuries are often followed by cerebral plasticity changes and increased intracerebral pressure (ICP). Aim of the review is to present current knowledge about amphetamines and other therapeutics concerning the recovery of brain injury based on contemporary findings.
On the one hand beneficial effects for cognitive and physical outcome after brain injury by coupling amphetamine with physical therapy could be demonstrated; on the other hand its efficacy was shown in only two out of 10 clinical trials.
Impairment after brain injury is reduced if adequate early treatment is established. On the basis of current findings amphetamine after brain injury cannot be recommended. In patients with an increased ICP the maintenance of an adequate cerebral perfusion pressure is required. In patients with increased ICP under controlled ventilation, the combination of ketamine with, for example, a short-acting benzodiazepine and opioid or methohexital is equally well tolerated. Ketamine decreases ICP without lowering blood pressure and cerebral perfusion pressure. Its neuroprotective property might reduce the exacerbation of brain injury following N-methyl-D-aspartate-receptor activation, neuronal apoptosis and systemic inflammatory responses.
颅脑创伤是青年患者死亡的主要原因，而卒中是老年患者致残的主要原因。这两种损伤通常都会导致大脑的可塑性变化和颅内压（ICP）升高。本综述旨在根据最新发现，介绍有关安非他命和其他治疗药物在脑损伤恢复方面的最新知识。
一方面，通过将安非他命与物理疗法相结合，可以证明其对颅脑损伤后的认知和身体恢复有有益影响；另一方面，在 10 项临床试验中，仅有两项显示其有效。
如果早期治疗得当，脑损伤后的损伤可以减轻。基于目前的研究结果，不建议在颅脑损伤后使用安非他命。对于 ICP 升高的患者，需要维持足够的脑灌注压。对于接受控制性通气的 ICP 升高患者，氯胺酮与例如短效苯二氮䓬类药物、阿片类药物或甲己炔巴比妥联合使用同样耐受良好。氯胺酮可降低 ICP，而不会降低血压和脑灌注压。其神经保护特性可能会减轻 N-甲基-D-天冬氨酸受体激活、神经元凋亡和全身炎症反应导致的脑损伤加重。
