Vella Michael A, Crandall Marie L, Patel Mayur B
Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Medical Center North, CCC-4312, 1161 21st Avenue South, Nashville, TN 37232-2730, USA; Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
Division of Acute Care Surgery, Department of Surgery, University of Florida, Jacksonville, 655 West 8th Street, Jacksonville, FL 32209, USA.
Surg Clin North Am. 2017 Oct;97(5):1015-1030. doi: 10.1016/j.suc.2017.06.003.
Traumatic brain injury (TBI) is a leading cause of death and disability in patients with trauma. Management strategies must focus on preventing secondary injury by avoiding hypotension and hypoxia and maintaining appropriate cerebral perfusion pressure (CPP), which is a surrogate for cerebral blood flow. CPP can be maintained by increasing mean arterial pressure, decreasing intracranial pressure, or both. The goal should be euvolemia and avoidance of hypotension. Other factors that deserve important consideration in the acute management of patients with TBI are venous thromboembolism, stress ulcer, and seizure prophylaxis, as well as nutritional and metabolic optimization.
创伤性脑损伤（TBI）是创伤患者死亡和致残的主要原因。管理策略必须侧重于通过避免低血压和缺氧以及维持适当的脑灌注压（CPP）来预防继发性损伤，脑灌注压是脑血流量的替代指标。可以通过提高平均动脉压、降低颅内压或两者兼用来维持CPP。目标应该是血容量正常并避免低血压。在TBI患者的急性管理中，其他值得重要考虑的因素包括静脉血栓栓塞、应激性溃疡和癫痫预防，以及营养和代谢优化。
