Gurney Jennifer M, Loos Paul E, Prins Mayumi, Van Wyck David W, McCafferty Randall R, Marion Donald W
Joint Trauma System/U.S. Army Institute of Surgical Research, 3698 Chambers Pass, San Antonio, TX 78234.
Non-Standard Medical Detachment, Office of Strategic Warfare, 1st Special Forces Command, Fort Bragg, NC 28310.
Mil Med. 2020 Jan 7;185(Suppl 1):148-153. doi: 10.1093/milmed/usz361.
Increased resource constraints secondary to a smaller medical footprint, prolonged evacuation times, or overwhelming casualty volumes all increase the challenges of effective management of traumatic brain injury (TBI) in the austere environment. Prehospital providers are responsible for the battlefield recognition and initial management of TBI. As such, targeted education is critical to efficient injury recognition, promoting both provider readiness and improved patient outcomes. When austere conditions limit or prevent definitive treatment, a comprehensive understanding of TBI pathophysiology can help inform acute care and enhance prevention of secondary brain injury. Field deployable, noninvasive TBI assessment and monitoring devices are urgently needed and are currently undergoing clinical evaluation. Evidence shows that the assessment, monitoring, and treatment in the first few hours and days after injury should focus on the preservation of cerebral perfusion and oxygenation. For cases where medical management is inadequate (eg, evidence of an enlarging intracranial hematoma), guidelines have been developed for the performance of cranial surgery by nonneurosurgeons. TBI management in the austere environment will continue to be a challenge, but research focused on improving evidence-based monitoring and therapeutic interventions can help to mitigate some of these challenges and improve patient outcomes.
由于医疗规模缩小、疏散时间延长或伤亡人数过多导致资源限制增加，所有这些都加大了在严峻环境中有效管理创伤性脑损伤（TBI）的挑战。院前急救人员负责在战场上识别和初步处理TBI。因此，有针对性的教育对于高效识别损伤至关重要，既能提高急救人员的准备程度，又能改善患者的治疗效果。当严峻条件限制或阻碍确定性治疗时，全面了解TBI病理生理学有助于指导急性护理并加强继发性脑损伤的预防。目前迫切需要可在现场部署的非侵入性TBI评估和监测设备，这些设备正在进行临床评估。有证据表明，受伤后的最初几个小时和几天内，评估、监测和治疗应侧重于维持脑灌注和氧合。对于医疗管理不足的情况（例如颅内血肿增大的迹象），已经制定了非神经外科医生进行颅骨手术的指南。在严峻环境中管理TBI仍将是一项挑战，但专注于改进基于证据的监测和治疗干预措施的研究有助于减轻其中一些挑战并改善患者的治疗效果。
