Department of Clinical Neurosciences, Division of Academic Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Department of Pediatric intensive Care, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
Pediatr Res. 2018 Jan;83(1-1):41-49. doi: 10.1038/pr.2017.215. Epub 2017 Dec 20.
Each year, the annual hospitalization rates of traumatic brain injury (TBI) in children in the United States are 57.7 per 100K in the <5 years of age and 23.1 per 100K in the 5-14 years age group. Despite this, little is known about the pathophysiology of TBI in children and how to manage it most effectively. Historically, TBI management has been guided by clinical examination. This has been assisted progressively by clinical imaging, intracranial pressure (ICP) monitoring, and finally a software that can calculate optimal brain physiology. Multimodality monitoring affords clinicians an early indication of secondary insults to the recovering brain including raised ICP and decreased cerebral perfusion pressure. From variables such as ICP and arterial blood pressure, correlations can be drawn to determine parameters of cerebral autoregulation (pressure reactivity index) and "optimal cerebral perfusion pressure" at which the vasculature is most reactive. More recently, significant advances using both direct and near-infrared spectroscopy-derived brain oxygenation plus cerebral microdialysis to drive management have been described. Here in, we provide a perspective on the state-of-the-art techniques recently implemented in clinical practice for pediatric TBI.
每年，美国儿童创伤性脑损伤（TBI）的年住院率为<5 岁儿童每 10 万人中有 57.7 人，5-14 岁儿童每 10 万人中有 23.1 人。尽管如此，对于儿童 TBI 的病理生理学以及如何最有效地治疗 TBI，人们知之甚少。从历史上看，TBI 的治疗一直以临床检查为指导。这逐渐得到了临床影像学、颅内压（ICP）监测的辅助，最终出现了一种可以计算最佳脑生理的软件。多模态监测为临床医生提供了有关恢复中大脑继发性损伤的早期迹象，包括颅内压升高和脑灌注压降低。从 ICP 和动脉血压等变量中，可以得出相关性，以确定脑自动调节的参数（压力反应指数）和“最佳脑灌注压”，在该压力下血管最具反应性。最近，使用直接和近红外光谱衍生的脑氧合加脑微透析来驱动治疗的技术取得了重大进展。在这里，我们提供了一个视角，介绍了最近在儿科 TBI 临床实践中实施的最新技术。
