Department of Neurology, Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA.
Department of Neurology, Boston University School of Medicine and Boston Medical Center, 72 East Concord Street, Collamore, C-3, Boston, MA 02118, USA.
Neurol Clin. 2021 May;39(2):443-469. doi: 10.1016/j.ncl.2021.02.009. Epub 2021 Mar 31.
Severe traumatic brain injury is a common problem. Current practices focus on the importance of early resuscitation, transfer to high-volume centers, and provider expertise across multiple specialties. In the emergency department, patients should receive urgent intracranial imaging and consideration for tranexamic acid. Close observation in the intensive care unit environment helps identify problems, such as seizure, intracranial pressure crisis, and injury progression. In addition to traditional neurologic examination, patients benefit from use of intracranial monitors. Monitors gather physiologic data on intracranial and cerebral perfusion pressures to help guide therapy. Brain tissue oxygenation monitoring and cerebromicrodialysis show promise in studies.
严重创伤性脑损伤是一个常见的问题。目前的治疗重点是早期复苏、转移到高容量中心以及多专科医生的专业知识。在急诊科，患者应接受紧急颅内成像和氨甲环酸的考虑。在重症监护病房环境中密切观察有助于发现问题，如癫痫发作、颅内压危机和损伤进展。除了传统的神经系统检查外，患者还受益于颅内监测器的使用。监测器收集颅内和脑灌注压的生理数据，以帮助指导治疗。脑组织氧监测和脑微透析在研究中显示出前景。
