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创伤性脑损伤患者的特定重症监护管理:现状与未来。

Specific intensive care management of patients with traumatic brain injury: Present and future.

作者信息

Chowdhury Tumul, Kowalski Stephen, Arabi Yaseen, Dash Hari Hara

机构信息

Department of Anesthesiology and Perioperative Medicine, Section of Critical Care, University of Manitoba, Winnipeg, Canada.

Department of Intensive Care, King Abdul-Aziz Medical City, Riyadh, Saudi Arabia.

出版信息

Saudi J Anaesth. 2014 Apr;8(2):268-75. doi: 10.4103/1658-354X.130746.

Abstract

Traumatic brain injury (TBI) is a major global problem and affects approximately 10 million peoples annually; therefore has a substantial impact on the health-care system throughout the world. In this article, we have summarized various aspects of specific intensive care management in patients with TBI including the emerging evidence mainly after the Brain Trauma Foundation (BTF) 2007 and also highlighted the scope of the future therapies. This review has involved the relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013), which specifically discussed about the topic. Though, BTF guideline based management strategies could provide standardized protocols for the management of patients with TBI and have some promising effects on mortality and morbidity; there is still need of inclusion of many suggestions based on various published after 2007. The main focus of majority of these trials remained to prevent or to treat the secondary brain injury. The future therapy will be directed to treat injured neurons and may benefit the outcome. There is also urgent need to develop some good prognostic indicators as well.

摘要

创伤性脑损伤(TBI)是一个重大的全球性问题,每年影响约1000万人;因此对全球医疗保健系统产生重大影响。在本文中,我们总结了TBI患者特定重症监护管理的各个方面,包括主要在脑创伤基金会(BTF)2007年之后出现的新证据,并强调了未来治疗的范围。本综述涉及相关临床试验和综述(2007年1月1日至2013年3月31日),这些文献专门讨论了该主题。尽管基于BTF指南的管理策略可为TBI患者的管理提供标准化方案,并对死亡率和发病率产生一些有前景的效果;但仍需要纳入2007年之后发表的各种文献中的许多建议。这些试验大多主要关注预防或治疗继发性脑损伤。未来的治疗将针对受损神经元,可能改善预后。迫切需要开发一些良好的预后指标。

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本文引用的文献

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Prognosis in severe brain injury.严重脑损伤的预后。
Crit Care Med. 2013 Apr;41(4):1104-23. doi: 10.1097/CCM.0b013e318287ee79.
3
Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain injury.高压氧疗法辅助治疗创伤性脑损伤。
Cochrane Database Syst Rev. 2012 Dec 12;12(12):CD004609. doi: 10.1002/14651858.CD004609.pub3.
4
Barbiturates for acute traumatic brain injury.用于急性创伤性脑损伤的巴比妥类药物。
Cochrane Database Syst Rev. 2012 Dec 12;12(12):CD000033. doi: 10.1002/14651858.CD000033.pub2.
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A trial of intracranial-pressure monitoring in traumatic brain injury.颅脑创伤患者颅内压监测的临床试验。
N Engl J Med. 2012 Dec 27;367(26):2471-81. doi: 10.1056/NEJMoa1207363. Epub 2012 Dec 12.
8
Osmotherapy in brain edema: a questionable therapy.脑水肿的渗透性治疗:一种值得质疑的治疗方法。
J Neurosurg Anesthesiol. 2012 Oct;24(4):407-12. doi: 10.1097/01.ana.0000419730.29492.8b.
10
Hyperosmolar therapy for raised intracranial pressure.高渗疗法治疗颅内压升高
N Engl J Med. 2012 Aug 23;367(8):746-52. doi: 10.1056/NEJMct1206321.

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