脑外伤患者围手术期液体及代谢管理

Perioperative management of fluid and metabolism in patients with traumatic brain injury

背景 在创伤性患者中,脑外伤（traumatic brain injury,TBI）逐渐成为致残甚至致死的主要因素.快速而有效的治疗,是该类患者取得良好预后的关键. 目的 对于TBI患者,围术期治疗的关键是维持患者生命体征平稳,避免血氧不足、低血压、贫血、低（高）碳酸血症、发热、低血糖等变化,也需关注颅内血肿、颅内高压、癫痫、感染、血管痉挛等引起继发性神经损伤的因素. 内容 TBI患者围术期液体和代谢管理包括维持脑灌注压、避免血糖较大波动及控制体温,是TBI患者预后的关键.维持脑灌注压的策略在于液体的选择类型及其输注量.维持良好的血糖范围,有利于患者预后.低体温对TBI患者的影响尚存在争议. 趋向 关注液体及代谢管理,逐渐成为TBI患者围术期管理的主要内容.

Background Traumatic brain injury （TBI） is a leading cause of morbidity and mortality in trauma patients.Objective Prompt institution of appropriate therapy is necessary to obtain a favorable outcome.Content The key points of perioperative management of head-injured patients is to stabilize the vital signs of those patients as well as to avoid systemic and intracranial insults.Those insults include hypoxemia,hypotension,anemia,hypocarbia,hypercarbia,pyrexia,hypoglycemia,intracranial hematoma,raised intracranial pressure,seizure,infection and vasospasm.Systematic and intracranial insults can cause secondary neuronal injury,therefore deteriorate the head-injured patients and bring unfavorable outcomes.Fortunately,by proper management of fluid and metabolism,most of those insults are avoidable and treatable in head-injured patients during the perioperative period.Management of fluid and metabolism includes sustaining cerebral perfusion pressure （CPP）,avoiding hyperglycemia or hypoglycermia and controlling body temperature.Choosing the right category and volume of fluid is important for maintaining CPP.The glucose level is related to the prognosis of patients with TBI.Whether hypothermia is beneficial for patients with TBI is still under debate.Trend Fluid and metabolism management is becoming a major subject for TBI patients.