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Title: Traumatic Intracranial Hypertension - What to do?
题目:创伤性颅内高压—如何处理?
Author 作者: Danya Khoujah
翻译:李辉 校对:肖锋
Elevated intracranial pressure (ICP), defined as >20mmHg, is frequently encountered in patients with severe traumatic brain injury (TBI). A step-wise approach would include:
颅内压(ICP)升高,定义为超过20 mmHg,常因患者遭受严重的脑外伤所致。阶梯式(治疗)方案包括:
1. Analgesia and sedation: frequently forgotten.
镇静和镇痛:常常被忽视
2. Hyperosmolar agents: both hypertonic saline and mannitol can be used. Neither is superior.
高渗性溶液:可以使用高渗盐水或甘露醇,没有哪一种会更好。
3. Induced arterial blood hypocarbia using hyperventilation (must monitor for cerebral ischemia)
通过低通气量诱发低二氧化碳血症(必须监测以防止脑缺血)
4. Barbiturates (last resort due to side effects)
巴比妥类药物(由于其并发症,可作为最后的手段)
5. Surgical:
手术
a. CSF drain
脑脊液引流
b. Decompressive craniectomy: benefits challenged by the DECRA study
去骨瓣减压:优势受到了DECRA研究的挑战
References 参考文献:
Stocchetti N, Maas AIR. Traumatic Intracranial Hypertension. N Engl J Med 2014; 370:2121-2130.
http://www.ncbi.nlm.nih.gov/pubmed/24869722