Department of Critical Care, Major Trauma and Head Injuries, Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK.
University of Sheffield Medical School, Sheffield, UK.
Anaesthesia. 2023 Apr;78(4):510-520. doi: 10.1111/anae.15898. Epub 2023 Jan 12.
Each year, approximately 70 million people suffer traumatic brain injury, which has a significant physical, psychosocial and economic impact for patients and their families. It is recommended in the UK that all patients with traumatic brain injury and a Glasgow coma scale ≤ 8 should be transferred to a neurosurgical centre. However, many patients, especially those in whom neurosurgery is not required, are not treated in, nor transferred to, a neurosurgical centre. This review aims to provide clinicians who work in non-neurosurgical centres with a summary of contemporary studies relevant to the critical care management of patients with traumatic brain injury. A targeted literature review was undertaken that included guidelines, systematic reviews, meta-analyses, clinical trials and randomised controlled trials (published in English between 1 January 2017 and 1 July 2022). Studies involving key clinical management strategies published before this time, but which have not been updated or repeated, were also eligible for inclusion. Analysis of the topics identified during the review was then summarised. These included: fundamental critical care management approaches (including ventilation strategies, fluid management, seizure control and osmotherapy); use of processed electroencephalogram monitoring; non-invasive assessment of intracranial pressure; prognostication; and rehabilitation techniques. Through this process, we have formulated practical recommendations to guide clinical practice in non-specialist centres.
每年，约有 7000 万人遭受创伤性脑损伤，这给患者及其家庭带来了重大的身体、心理社会和经济影响。英国建议所有创伤性脑损伤且格拉斯哥昏迷量表评分≤8 的患者都应转至神经外科中心。然而，许多患者，尤其是那些不需要神经外科治疗的患者，并未在神经外科中心接受治疗或转至神经外科中心。本综述旨在为非神经外科中心的临床医生提供与创伤性脑损伤患者重症监护管理相关的当代研究摘要。进行了有针对性的文献综述，包括指南、系统评价、荟萃分析、临床试验和随机对照试验（发表于 2017 年 1 月 1 日至 2022 年 7 月 1 日期间的英文文献）。在此之前发表但未更新或重复的涉及关键临床管理策略的研究也符合纳入标准。然后对综述中确定的主题进行了分析。这些包括：基本重症监护管理方法（包括通气策略、液体管理、癫痫控制和渗透压治疗）；使用处理后的脑电图监测；颅内压的非侵入性评估；预后；和康复技术。通过这个过程，我们制定了实用的建议，以指导非专业中心的临床实践。
