重型创伤性颅脑损伤患者自发性过度通气的研究进展

Research progress of spontaneous hyperventilation in patients with severe traumatic brain injury

预防和减轻继发性脑损伤是重型创伤性颅脑损伤(sTBI)患者重症监护治疗过程中的重点和难点。诱导性过度通气(IHV)可通过减少脑血容量快速降低颅内压,但由于脑血管收缩带来的脑血流减少会加重脑组织的缺血缺氧,目前已不再推荐用于sTBI患者的常规治疗。与此同时,以不同程度的低碳酸血症为特征的自发性过度通气(SHV)在急性创伤性脑损伤患者中较为常见,且由于与患者的神经功能不良转归具有明显的相关性,近年来逐渐受到重视。本文从流行病学、病理生理学效应、临床预后及干预措施等角度对SHV在sTBI中的研究现状进行综述,以期提高重症医师的认知水平,进而重视并推动相关临床及基础研究的开展。

Secondary brain injury prevention is critical for the severe traumatic brain injury treatment.Induced hyperventilation can decrease intracranial pressure by reducing cerebral blood volume;however,it is not recommended as routine therapy in severe traumatic brain injury since the decreased cerebral blood flow which may aggravate brain ischemia.Meanwhile,a high prevalence of spontaneous hyperventilation in patients with an acute brain injury,which is characterized as certain degrees of hypocapnia,has attracted more attention in recent years due to closely related to the long-term adverse outcome.We has reviewed the epidemiology,pathophysiology mechanisms,clinical prognosis,and prevention methods of spontaneous hyperventilation in severe traumatic brain injury,aiming to improve the critical care physicians'awareness and facilitate fundamental and clinical research.