摘要
急性重症脑损伤患者的呼吸管理是重症管理整体的重要组成,脑损伤后一系列特殊的病理生理改变和临床表现使呼吸管理与非神经系统疾病有所不同。保护性肺通气策略和临床试验的证据使传统呼吸管理观点受到质疑与挑战,低碳酸血症和低呼气末正压(PEEP)策略不再是脑损伤患者呼吸管理的常规选项,但呼吸管理仍需遵循"避免再损伤"的原则。多模态神经监测有助于进行呼吸管理时不断优化颅内压、脑灌注和脑氧代谢的目标,做到呼吸管理的精准化,展现了良好的前景。
Respiratory management in patients with acute severe brain injury is an important part of the integrated critical management.A series of special pathophysiological changes and clinical manifestations after brain injury make it different from non-central nervous system diseases.Lung protective ventilation strategy and evidence from clinical trials have challenged the traditional view of respiratory management:hypocarbonemia and low PEEP strategy are no longer routine options for respiratory management in patients with brain injury,but respiratory management still needs to follow the principle of "avoiding secondary injury".Multimodal neuromonitoring shows good prospects,which is helpful to achieve the precision of respiratory management by optimizing the targets of the management of intracranial pressure,cerebral perfusion and cerebral oxygen metabolism.
作者
刘景仑
张丹
LIU Jinglun;ZHANG Dan(Department of Emergency&Critical Care Medicine,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China)
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2019年第12期1031-1035,共5页
Chinese Journal of Practical Internal Medicine
关键词
急性重症脑损伤
呼吸管理
多模态神经监测
acute severe brain injury
respiratory management
multimodal neuromonitoring
