神经重症监护的最新进展

Yuqing Chen , Shuya Wang , Shanshan Xu , Ningyuan Xu , Linlin Zhang , Jianxin Zhou
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引用次数: 0

摘要

本文综述了神经危重症护理的最新研究进展和指南更新。对于缺血性脑卒中的治疗,取栓治疗时间窗的延长以及新型溶栓药物和策略的出现,为患者的康复带来了更大的希望。微创血肿清除和目标导向捆绑管理在脑出血治疗中显示出临床益处。在动脉瘤性蛛网膜下腔出血(aSAH)的治疗中,早期腰椎引流可降低梗死的风险。颅脑减压术治疗重型颅脑损伤也获得了高质量的证据支持。然而,创伤性脑损伤患者的多模式脑监测策略需要进一步优化。对于心脏骤停患者,体外心肺复苏可以降低住院死亡率,改善长期神经预后。对于神经危重症患者,在多模式神经监测、血流动力学管理、气道管理和呼吸治疗、抗癫痫治疗等领域出现了大量高质量的研究。2023年,aSAH指南在过去十年中首次进行了更新,旨在为临床护理提供循证实践建议。制定了指导神经危重症患者镇痛镇静的中国专家共识,制定了一套神经危重症医疗质量指标,促进了神经危重症医疗质量的规范化和同质化提升。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Current advances in neurocritical care
This review summarizes the current research advances and guideline updates in neurocritical care. For the therapy of ischemic stroke, the extended treatment time window for thrombectomy and the emergence of novel thrombolytic agents and strategies have brought greater hope for patient recovery. Minimally invasive hematoma evacuation and goal-directed bundled management have shown clinical benefits in treating cerebral hemorrhage. In the treatment of aneurysmal subarachnoid hemorrhage (aSAH), early lumbar drainage can reduce the risk of infarction. Decompressive craniectomy for severe traumatic brain injury has also obtained high-quality evidence support. However, multimodal brain monitoring strategies for patients with traumatic brain injury need further optimization. For patients with cardiac arrest, extracorporeal cardiopulmonary resuscitation can reduce in-hospital mortality and improve long-term neurological prognosis. For neurocritical care patients, abundant high-quality studies have emerged in areas including multimodal neuromonitoring, hemodynamic management, airway management and respiratory therapy, and antiepileptic treatment. In 2023, the guidelines for aSAH have been updated for the first time in the past decade, aiming to provide evidence-based practice recommendations for clinical care. Chinese expert consensuses have also been formulated to guide analgesia and sedation for neurocritical care patients and developed a set of medical quality indicators on neurocritical care, which will enhance standardization and homogenization improvement in neurocritical care quality.
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来源期刊
Journal of intensive medicine
Journal of intensive medicine Critical Care and Intensive Care Medicine
CiteScore
1.90
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0.00%
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审稿时长
58 days
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