Menon D K, Ercole A
Division of Anaesthesia, University of Cambridge and Neurosciences/Trauma Critical Care Unit, Addenbrooke's Hospital, Cambridge, UK.
Division of Anaesthesia, University of Cambridge and Neurosciences/Trauma Critical Care Unit, Addenbrooke's Hospital, Cambridge, UK.
Handb Clin Neurol. 2017;140:239-274. doi: 10.1016/B978-0-444-63600-3.00014-3.
Traumatic brain injury (TBI) is a growing global problem, which is responsible for a substantial burden of disability and death, and which generates substantial healthcare costs. High-quality intensive care can save lives and improve the quality of outcome. TBI is extremely heterogeneous in terms of clinical presentation, pathophysiology, and outcome. Current approaches to the critical care management of TBI are not underpinned by high-quality evidence, and many of the current therapies in use have not shown benefit in randomized control trials. However, observational studies have informed the development of authoritative international guidelines, and the use of multimodality monitoring may facilitate rational approaches to optimizing acute physiology, allowing clinicians to optimize the balance between benefit and risk from these interventions in individual patients. Such approaches, along with the emerging impact of advanced neuroimaging, genomics, and protein biomarkers, could lead to the development of precision medicine approaches to the intensive care management of TBI.
创伤性脑损伤（TBI）是一个日益严重的全球性问题，它造成了巨大的残疾和死亡负担，并产生了高昂的医疗费用。高质量的重症监护可以挽救生命并改善预后质量。TBI在临床表现、病理生理学和预后方面具有极大的异质性。目前TBI的重症监护管理方法缺乏高质量证据的支持，许多现行疗法在随机对照试验中并未显示出益处。然而，观察性研究为权威性国际指南的制定提供了依据，多模态监测的应用可能有助于采用合理方法优化急性生理学状况，使临床医生能够在个体患者中优化这些干预措施的利弊平衡。这些方法，连同先进神经影像学、基因组学和蛋白质生物标志物的新影响，可能会促成针对TBI重症监护管理的精准医学方法的发展。
