Division of Traumatology, Surgical Critical Care, and Emergency Surgery, Department of Surgery.
Division of Neurocritical Care, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Curr Opin Crit Care. 2022 Dec 1;28(6):715-724. doi: 10.1097/MCC.0000000000001005. Epub 2022 Oct 20.
This review will highlight the latest research relevant to the clinical care of traumatic brain injury (TBI) patients over the last 2 years while underscoring the implications of these advances in the understanding of diagnosis, treatment, and prognosis of TBI.
Brain tissue oxygenation monitoring can identify hypoperfusion as an adjunct to intracerebral pressure monitoring. Multiple biomarker assays are now available to help clinicians screen for mild TBI and biomarker elevations correlate with the size of intracranial injury. Beta-blocker exposure following TBI has demonstrated a survival benefit in those with TBI though the mechanism for this remains unknown. The optimal timing for venous thromboembolism prophylaxis for TBI patients is still uncertain.
The current characterization of TBI as mild, moderate, or severe fails to capture the complexity of the disease process and helps little with prognostication. Molecular biomarkers and invasive monitoring devices including brain tissue oxygenation and measures of cerebral autoregulation are being utilized more commonly and can help guide therapy. Extracranial complications following TBI are common and include infection, respiratory failure, coagulopathy, hypercoagulability, and paroxysmal sympathetic hyperactivity.
本篇综述将重点介绍过去 2 年中与创伤性脑损伤（TBI）患者临床护理相关的最新研究进展，同时强调这些进展对 TBI 的诊断、治疗和预后的理解的意义。
脑组织氧监测可以识别灌注不足，作为颅内压监测的辅助手段。现在有多种生物标志物检测可供临床医生用于筛查轻度 TBI，生物标志物的升高与颅内损伤的大小相关。TBI 后β受体阻滞剂的暴露已证明对 TBI 患者具有生存获益，但其机制尚不清楚。TBI 患者预防静脉血栓栓塞的最佳时机仍不确定。
当前将 TBI 分为轻度、中度或重度并不能反映疾病过程的复杂性，对预后也没有太大帮助。分子生物标志物和有创监测设备，包括脑组织氧和脑自动调节的测量，越来越多地被应用，并有助于指导治疗。TBI 后的颅外并发症很常见，包括感染、呼吸衰竭、凝血功能障碍、高凝状态和阵发性交感神经兴奋。
