Ziaka Mairi, Hautz Wolf, Exadaktylos Aristomenis
Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3012 Bern, Switzerland.
Academic Department of Emergency Medicine, School of Medicine, University of Cyprus, 1678 Nicosia, Cyprus.
J Clin Med. 2025 Sep 5;14(17):6289. doi: 10.3390/jcm14176289.
The current management of severe traumatic brain injury (TBI) focuses on maintaining cerebral perfusion pressure (CPP) to prevent or minimize secondary brain injury, limit cerebral edema, optimize oxygen delivery to the brain, and reduce primary neuronal damage by addressing contributing risk factors such as hypotension and hypoxia. Hypotension and cardiac dysfunction are common in patients with severe TBI, often requiring treatment with intravenous fluids and vasopressors. The primary categories of resuscitation fluids include crystalloids, colloids (such as albumin), and blood products. Fluid osmolarity is a critical consideration in TBI patients, as hypotonic fluids, such as balanced crystalloids, may increase the risk of cerebral edema development and worsening. Hyperosmolar therapy is a common therapeutic approach in patients with intracranial hypertension; however, its use as a resuscitation fluid is not associated with benefits in patients with TBI and is not recommended. Given the contradictory results of trials on blood transfusion strategies in patients with TBI, the transfusion approach should be tailored to individual systemic and cerebral physiological parameters. The evaluation of recent randomized clinical trials will provide insight into whether a liberal or restrictive transfusion strategy is preferred for this patient population. Hemodynamic and multimodal neurological monitoring to assess cerebral oxygenation, autoregulation, and metabolism are essential tools for detecting early hemodynamic alterations and cerebral injury, guiding resuscitation management, and contributing to improved outcomes.
目前，重度创伤性脑损伤（TBI）的管理重点在于维持脑灌注压（CPP），以预防或尽量减少继发性脑损伤、限制脑水肿、优化脑部的氧气输送，并通过解决诸如低血压和缺氧等相关危险因素来减少原发性神经元损伤。低血压和心脏功能障碍在重度TBI患者中很常见，通常需要静脉输液和血管加压药进行治疗。复苏液体的主要类别包括晶体液、胶体液（如白蛋白）和血液制品。液体渗透压是TBI患者的一个关键考虑因素，因为低渗液体，如平衡晶体液，可能会增加脑水肿发展和恶化的风险。高渗疗法是颅内高压患者常用的治疗方法；然而，将其用作复苏液体对TBI患者并无益处，因此不建议使用。鉴于TBI患者输血策略试验结果相互矛盾，输血方法应根据个体的全身和脑部生理参数进行调整。对近期随机临床试验的评估将有助于了解该患者群体更适合采用宽松还是严格的输血策略。血流动力学和多模式神经监测用于评估脑氧合、自动调节和代谢，是检测早期血流动力学改变和脑损伤、指导复苏管理以及改善预后的重要工具。
