Barone D G, Czosnyka M
Department of Neurosurgery, The Walton Centre, Liverpool L9 7AL, UK.
Department of Academic Neurosurgery, Addenbrooke's Hospital, University of Cambridge, P.O. Box 167, Cambridge CB2 0QQ, UK.
ScientificWorldJournal. 2014 Jan 23;2014:795762. doi: 10.1155/2014/795762. eCollection 2014.
The ability to measure reliably the changes in the physical and biochemical environment after a brain injury is of great value in the prevention, treatment, and understanding of the secondary injuries. Three categories of multimodal brain monitoring exist: direct signals which are monitored invasively; variables which may be monitored noninvasively; and variables describing brain pathophysiology which are not monitored directly but are calculated at the bedside by dedicated computer software. Intracranial pressure (ICP) monitoring, either as stand-alone value or study of a dynamic trend, has become an important diagnostic tool in the diagnosis and management of multiple neurological conditions. Attempts have been made to measure ICP non-invasively, but this is not a clinical reality yet. There is contrasting evidence that monitoring of ICP is associated with better outcome, and further RCTs based on management protocol are warranted. Computer bedside calculation of "secondary parameters" has shown to be potentially helpful, particularly in helping to optimize "CPP-guided therapy." In this paper we describe the most popular invasive and non invasive monitoring modalities, with great attention to their clinical interpretation based on the current published evidence.
可靠测量脑损伤后物理和生化环境变化的能力，对于预防、治疗和理解继发性损伤具有重要价值。存在三类多模态脑监测：通过侵入性方式监测的直接信号；可通过非侵入性方式监测的变量；以及描述脑病理生理学的变量，这些变量并非直接监测，而是由专用计算机软件在床边计算得出。颅内压（ICP）监测，无论是作为单一数值还是动态趋势研究，已成为多种神经系统疾病诊断和管理中的重要诊断工具。人们已尝试进行非侵入性颅内压测量，但这在临床上尚未成为现实。有相互矛盾的证据表明，颅内压监测与更好的预后相关，因此有必要基于管理方案开展进一步的随机对照试验。床边计算机计算“次要参数”已显示出潜在的帮助，特别是在帮助优化“脑灌注压指导治疗”方面。在本文中，我们描述了最常用的侵入性和非侵入性监测方式，并根据当前已发表的证据，对其临床解读给予了高度关注。
