Figaji Anthony A, Graham Fieggen A, Mankahla Ncedile, Enslin Nico, Rohlwink Ursula K
Division of Neurosurgery and Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
Division of Neurosurgery, University of Cape Town, Cape Town, South Africa.
Childs Nerv Syst. 2017 Oct;33(10):1651-1661. doi: 10.1007/s00381-017-3562-3. Epub 2017 Aug 14.
In recent years, much progress has been made in our understanding of traumatic brain injury (TBI). Clinical outcomes have progressively improved, but evidence-based guidelines for how we manage patients remain surprisingly weak. The problem is that the many interventions and strategies that have been investigated in randomized controlled trials have all disappointed. These include many concepts that had become standard care in TBI. And that is just for adult TBI; in children, the situation is even worse. Not only is pediatric care more difficult than adult care because physiological norms change with age, but also there is less evidence for clinical practice. In this article, we discuss the heterogeneity inherent in TBI and why so many clinical trials have failed. We submit that a key goal for the future is to appreciate important clinical differences between patients in their pathophysiology and their responses to treatment. The challenge that faces us is how to rationally apply therapies based on the specific needs of an individual patient. In doing so, we may be able to apply the principles of precision medicine approaches to the patients we treat.
近年来，我们对创伤性脑损伤（TBI）的认识取得了很大进展。临床结果逐渐改善，但关于如何管理患者的循证指南仍然出奇地薄弱。问题在于，在随机对照试验中研究的许多干预措施和策略都令人失望。这些包括许多已成为TBI标准治疗的概念。而这仅仅是针对成人TBI而言；在儿童中，情况更糟。儿科护理不仅因为生理规范随年龄变化而比成人护理更困难，而且临床实践的证据也更少。在本文中，我们讨论了TBI固有的异质性以及为何如此多的临床试验失败。我们认为，未来的一个关键目标是认识到患者在病理生理学和对治疗的反应方面的重要临床差异。我们面临的挑战是如何根据个体患者的特定需求合理应用治疗方法。这样做时，我们或许能够将精准医学方法的原则应用于我们所治疗的患者。
