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创伤性颅内高压—如何处理?
原作者: Danya Khoujah,李辉译,肖锋 发布日期:2015-03-02

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