重型颅脑损伤后颅内高压的治疗研究进展

重型颅脑损伤后颅内压增高预示着不良的神经功能预后和极高的死亡率,一直是临床治疗中的研究热点,可采取高渗性脱水,亚低温疗法,巴比妥昏迷治疗及外科手术干预等治疗措施控制颅内压。由于亚低温治疗会增加患者发生肺炎的风险,巴比妥类药物副作用较大,现均已少用。近来研究发现,监测颅内压、脑灌注压、脑组织氧分压并指导临床治疗,可降低死亡率与改善预后。也有研究发现去骨瓣减压术治疗顽固性颅内高压与神经功能预后较差有关。目前关于颅内高压治疗的最佳方案仍存在争议,未来还需根据患者病情,为其制定规范化与个体化的治疗方案,预防继发性颅脑损伤,降低颅内压。本文就近年来重型颅脑损伤后颅内高压的治疗进展进行阐述。

Progress in the Treatment of Intracranial Hypertension after Severe Traumatic Brain Injury

Increased intracranial pressure after severe traumatic brain injury indicates a poorer neurological outcome and higher mortality, the treatment of intracranial hypertension after severe traumatic brain injury has been the research focus of the clinical. The use of hypertonic dehydration agents, therapeutic hypothermia, barbiturate coma therapy, and surgical options can reduce the intracranial pressure. However, patients receiving hypothermia were at a greater risk of developing pneumonia, and barbiturate coma has become less popular for patients with intracranial hypertension because of its side-effects. In recent studies, the monitoring of intracranial pressure, cerebral perfusion pressure and brain tissue oxygen was used to guide treatment, associated with better survival and improved neurological outcome. The decompressive craniectomy in patients to control the refractory intracranial hypertension exhibited a poorer neurological function. In the future, patients need standardized and individualized program to prevent the secondary brain injury and control the intracranial pressure better. This article is about the recent progress in the treatment of intracranial hypertension after severe traumatic brain injury.