Zhang Dan, Sheng Yanzhi, Wang Chengbin, Chen Wei, Shi Xiaofeng
Longgang Central Hospital of Shenzhen, Guangdong, China.
Shenzhen College of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangdong, China.
Front Neurol. 2024 Sep 17;15:1423329. doi: 10.3389/fneur.2024.1423329. eCollection 2024.
Traumatic brain injury (TBI) is a significant global public health issue, heavily impacting human health, especially in low-and middle-income areas. Despite numerous guidelines and consensus statements, TBI fatality rates remain high. The pathogenesis of severe TBI is closely linked to rising intracranial pressure (ICP). Elevated intracranial pressure can lead to cerebral herniation, resulting in respiratory and circulatory collapse, and ultimately, death. Managing intracranial pressure (ICP) is crucial in neuro-intensive care. Timely diagnosis and precise treatment of elevated ICP are essential. ICP monitoring provides real-time insights into a patient's condition, offering invaluable guidance for comprehensive management. ICP monitoring and standardization can effectively reduce secondary nerve damage, lowering morbidity and mortality rates. Accurately assessing and using true ICP values to manage TBI patients still depends on doctors' clinical experience. This review discusses: (a) Epidemiological disparities of traumatic brain injuries across countries with different income levels worldwide; (b) The significance and function of ICP monitoring; (c) Current status and challenges of ICP monitoring; (d) The impact of decompressive craniectomy on reducing intracranial pressure; and (e) Management of TBI in diverse income countries. We suggest a thorough evaluation of ICP monitoring, head CT findings, and GCS scores before deciding on decompressive craniectomy. Personalized treatment should be emphasized to assess the need for surgical decompression in TBI patients, offering crucial insights for clinical decision-making.
创伤性脑损伤（TBI）是一个重大的全球公共卫生问题，严重影响人类健康，尤其是在低收入和中等收入地区。尽管有众多指南和共识声明，但TBI的死亡率仍然很高。重度TBI的发病机制与颅内压（ICP）升高密切相关。颅内压升高可导致脑疝，进而引起呼吸和循环衰竭，最终导致死亡。在神经重症监护中，控制颅内压（ICP）至关重要。及时诊断和精确治疗颅内压升高至关重要。ICP监测可实时了解患者病情，为综合管理提供宝贵指导。ICP监测及标准化可有效减少继发性神经损伤，降低发病率和死亡率。准确评估并利用真实的ICP值来管理TBI患者仍依赖于医生的临床经验。本综述讨论了：（a）全球不同收入水平国家创伤性脑损伤的流行病学差异；（b）ICP监测的意义和作用；（c）ICP监测的现状和挑战；（d）减压性颅骨切除术对降低颅内压的影响；以及（e）不同收入国家的TBI管理。我们建议在决定进行减压性颅骨切除术之前，对ICP监测、头部CT检查结果和格拉斯哥昏迷评分（GCS）进行全面评估。应强调个性化治疗，以评估TBI患者手术减压的必要性，为临床决策提供关键见解。
