Stover John F
John F Stover, Surgical Intensive Care Medicine, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland.
World J Crit Care Med. 2012 Feb 4;1(1):15-22. doi: 10.5492/wjccm.v1.i1.15.
Evolving brain damage following traumatic brain injury (TBI) is strongly influenced by complex pathophysiologic cascades including local as well as systemic influences. To successfully prevent secondary progression of the primary damage we must actively search and identify secondary insults e.g. hypoxia, hypotension, uncontrolled hyperventilation, anemia, and hypoglycemia, which are known to aggravate existing brain damage. For this, we must rely on specific cerebral monitoring. Only then can we unmask changes which otherwise would remain hidden, and prevent adequate intensive care treatment. Apart from intracranial pressure (ICP) and calculated cerebral perfusion pressure (CPP), extended neuromonitoring (SjvO2, ptiO2, microdialysis, transcranial Doppler sonography, electrocorticography) also allows us to define individual pathologic ICP and CPP levels. This, in turn, will support our therapeutic decision-making and also allow a more individualized and flexible treatment concept for each patient. For this, however, we need to learn to integrate several dimensions with their own possible treatment options into a complete picture. The present review summarizes the current understanding of extended neuromonitoring to guide therapeutic interventions with the aim of improving intensive care treatment following severe TBI, which is the basis for ameliorated outcome.
创伤性脑损伤（TBI）后不断演变的脑损伤受到包括局部和全身影响在内的复杂病理生理级联反应的强烈影响。为了成功预防原发性损伤的继发性进展，我们必须积极寻找并识别继发性损伤，例如缺氧、低血压、未控制的过度换气、贫血和低血糖，这些已知会加重现有的脑损伤。为此，我们必须依靠特定的脑监测。只有这样，我们才能发现那些否则会被隐藏的变化，并采取适当的重症监护治疗措施。除了颅内压（ICP）和计算得出的脑灌注压（CPP）外，扩展神经监测（颈静脉球血氧饱和度[SjvO2]、脑组织氧分压[ptiO2]、微透析、经颅多普勒超声、皮层脑电图）还能让我们确定个体的病理性ICP和CPP水平。这反过来将支持我们的治疗决策，并为每个患者提供更个性化、更灵活的治疗方案。然而，为此我们需要学会将几个维度及其各自可能的治疗选择整合到一个完整的图景中。本综述总结了目前对扩展神经监测的认识，以指导治疗干预，目的是改善重度TBI后的重症监护治疗，这是改善预后的基础。
