Erhard J, Waydhas C, Lackner C K, Kanz K G, Ruchholtz S, Schweiberer L
Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität München.
Unfallchirurg. 1996 Aug;99(8):534-40.
Both prehospital and hospital management of patients with severe head injury has clearly improved in the last decades. There is a greater knowledge of how secondary brain injury is caused and how it can be prevented. Intracranial mechanisms (e.g. haematoma and elevated intracranial pressure and systemic mechanism (e.g. shock and hypoxaemia) are two of the major causes of secondary brain injury. Adequate prehospital evaluation and treatment determine the later outcome for the patient. The Glasgow Coma Scale has become the standard score for assessing the level of consciousness. Early prehospital treatment must prevent secondary brain damage through adequate oxygenation (intubation, ventilation) and a sufficient cerebral perfusion pressure (treatment of shock). The neck of the patient should be positioned straight and the upper part of the body should be elevated to about 30 degrees. The prophylactic use of steroids, mannitol or high dose barbiturates is not indicated. Aggressive hyperventilation (pCO2 < 30 mmHg), especially during the first few days after severe brain injury, should be avoided.
在过去几十年中，严重颅脑损伤患者的院前和院内管理都有了明显改善。人们对继发性脑损伤的成因及预防方法有了更深入的了解。颅内机制（如血肿和颅内压升高）和全身机制（如休克和低氧血症）是继发性脑损伤的两个主要原因。充分的院前评估和治疗决定了患者的后期预后。格拉斯哥昏迷量表已成为评估意识水平的标准评分。早期院前治疗必须通过充分的氧合（插管、通气）和足够的脑灌注压（治疗休克）来预防继发性脑损伤。患者的颈部应保持伸直，身体上部应抬高约30度。不建议预防性使用类固醇、甘露醇或大剂量巴比妥类药物。应避免积极过度通气（pCO2 < 30 mmHg），尤其是在严重脑损伤后的头几天。
