Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy -
Department of Anesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Center, Grenoble Alpes University Hospital, Grenoble, France.
Minerva Anestesiol. 2022 May;88(5):380-389. doi: 10.23736/S0375-9393.21.15927-9. Epub 2021 Oct 12.
Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide. Head injured patients may frequently require emergency neurosurgery. The perioperative TBI period is very important as many interventions done in this stage can have a profound effect on the long-term neurological outcome. This practical concise narrative review focused mainly on: 1) the management of severe TBI patients with neurosurgical lesions admitted to a spoke center (i.e. hospital without neurosurgery) and therefore needing a transfer to the hub center (i.e. hospital with neurosurgery); 2) the management of severe TBI patients with intracranial hypertension/brain herniation awaiting for neurosurgery; and 3) the neuromonitoring-oriented management in the immediate post-operative period. The proposals presented in this review mainly apply to severe TBI patients admitted to high-income countries.
创伤性脑损伤（TBI）是全球范围内导致死亡和残疾的主要原因。头部受伤的患者可能经常需要紧急神经外科手术。围手术期 TBI 期间非常重要，因为在此阶段进行的许多干预措施可能对长期神经预后产生深远影响。本实用简明叙述性综述主要侧重于：1）管理接受神经外科病变的严重 TBI 患者进入辐条中心（即无神经外科的医院），因此需要转移到枢纽中心（即有神经外科的医院）；2）管理伴有颅内压增高/脑疝的严重 TBI 患者等待神经外科手术；3）术后即刻的神经监测导向管理。本综述中提出的建议主要适用于收入较高国家的严重 TBI 患者。
