Helbok Raimund, Beer Ronny
Department of Neurology, Neurocritical Care Unit, Medical University of Innsbruck, Innsbruck, Austria.
Department of Neurology, Neurocritical Care Unit, Medical University of Innsbruck, Innsbruck, Austria.
Handb Clin Neurol. 2017;146:237-258. doi: 10.1016/B978-0-12-804279-3.00014-9.
Traumatic brain injury is a major cause of morbidity and mortality worldwide. Pathophysiologic mechanisms of secondary brain injury are complex and still not fully understood. Cerebrospinal fluid deserves attention to detect infectious complications and to identify biomarkers of disease severity and impending secondary brain injury. As an adjunct, cerebral microdialysis (CMD) allows online measurements of biomarkers derived directly from brain extracellular fluid. We critically review relevant literature related to infectious complications detectable in the cerebrospinal fluid in trauma patients. We then address the current role of CMD in clinical practice in the identification and prediction of secondary brain injury after severe trauma. Moreover we discuss the role of CMD-derived biomarkers in prognostication. Finally we challenge common treatment strategies and provide novel treatment concepts using brain-derived biomarkers as endpoints. We suggest a personalized treatment strategy for individual patients with severe traumatic brain injury.
创伤性脑损伤是全球发病和死亡的主要原因。继发性脑损伤的病理生理机制复杂，仍未完全明确。脑脊液在检测感染性并发症以及识别疾病严重程度和即将发生的继发性脑损伤的生物标志物方面值得关注。作为一种辅助手段，脑微透析（CMD）可对直接源自脑细胞外液的生物标志物进行在线测量。我们批判性地回顾了与创伤患者脑脊液中可检测到的感染性并发症相关的文献。然后我们阐述了CMD在临床实践中对严重创伤后继发性脑损伤的识别和预测方面的当前作用。此外，我们讨论了CMD衍生的生物标志物在预后评估中的作用。最后，我们对常见的治疗策略提出质疑，并提供以脑源性生物标志物为终点的新型治疗理念。我们建议针对重度创伤性脑损伤的个体患者采用个性化治疗策略。
