严重创伤性颅脑损伤的颅内压监测与处置

Monitoring and management of intracranial pressure in pediatric severe traumatic brain injury

颅内压(ICP)持续增高是严重创伤性颅脑损伤(sTBI)发生继发性脑损伤的关键因素,致力于降低ICP的治疗可以改善预后。目前ICP监测分为有创和无创。脑室外引流接压力传感器测量是ICP测量的金标准,无创监测临床应用增多,但尚不能完全替代有创监测以满足临床治疗决策所需。sTBI的治疗策略应根据操作难易和治疗风险分层实施。治疗目标是控制ICP,优化脑灌注和氧供,预防或逆转脑疝。sTBI患儿从初始治疗开始,逐渐升级治疗方案直至实现治疗目标,以改善sTBI患儿的预后。

Continuous intracranial hypertension in patients with severe traumatic brain injury(sTBI)is the key factor of secondary brain injury.The management of elevated intracranial pressure(ICP)can improve the outcome.ICP monitoring methods are divided into invasive and non-invasive.Non-invasive monitoring has not yet reached a level of sufficient accuracy for treatment decisions in clinical practice as invasive monitoring.The gold standard to measure ICP is through an external ventricular drain coupled to an external fluid-filled transducer measurement.The treatment strategy of sTBI is stratified.It can be divided into baseline care,first tier therapies and second tier therapies according to the difficulty of management and treatment risk.The therapeutic targets are mitigating intracranial hypertension,optimizing cerebral perfusion and oxygenation,and preventing or reversing cerebral herniation.From the baseline care,sTBI patients gradually upgrade the therapies until the targets are achieved,so to improve the outcomes of sTBI children.