University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
J Neurointerv Surg. 2011 Mar;3(1):34-7. doi: 10.1136/jnis.2010.002865. Epub 2010 Aug 25.
Neurocritical care has evolved over the past 20 years in parallel with the growth of critical care medicine and the stunning developments in the fields of neurology and neurosurgery. Although clinical trials are needed, there is preliminary evidence that induced hypertension and hypothermia can improve outcomes. The optimal threshold for transfusion of red cells remains unknown in patients with ischemic stroke and similarly further studies are needed to examine glycemic control and identify which patients may benefit most from aggressive insulin therapy. Finally, optimization of medical treatment is key in the care of the stroke patient and we should be cautious when prognosticating early in the setting of acute stroke and be aware of the potential effect 'do not resuscitate' status may have on patient outcome.
神经危重症医学在过去的 20 年中与重症监护医学的发展以及神经病学和神经外科学领域的惊人发展并行发展。尽管需要进行临床试验，但有初步证据表明诱导高血压和低温可以改善预后。在缺血性脑卒中患者中，红细胞输注的最佳阈值尚不清楚，同样需要进一步研究来检查血糖控制，并确定哪些患者可能从强化胰岛素治疗中获益最大。最后，优化药物治疗是脑卒中患者护理的关键，我们在急性脑卒中早期应谨慎进行预后判断，并意识到“不复苏”状态对患者预后可能产生的潜在影响。
