摘要
在神经重症重点病种的临床诊疗方面,延长时间窗的取栓试验以及新的溶栓药物和溶栓方案的出现给缺血性卒中患者带来更大希望,微创血肿清除以及目标导向的集束化方案在治疗脑出血方面显示出令人惊喜的临床获益,重型颅脑损伤患者的去骨瓣治疗也涌现出高质量证据。在神经重症患者的重症管理方面,神经功能多模态监测、气道管理和呼吸治疗、抗癫痫管理方面也出现了一些高质量研究。在2022~2023年,动脉瘤性蛛网膜下腔出血指南和自发性脑出血指南进行了更新,神经重症患者镇痛镇静治疗和营养治疗也推出了中国专家共识。总体而言,神经重症领域取得可喜进展,但未来仍需更多高质量大样本的研究来加以完善,以指导精准化、个性化治疗。
In the treatment of ischemic stroke,the extended 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.Decompressive craniectomy for severe traumatic brain injury has also obtained high-quality evidence support.In the critical care of neurocritical patients,abundant high-quality studies have emerged in the areas including multimodal neuromonitoring,airway management and respiratory therapy,and antiepileptic treatment.In 2022 and 2023,the guidelines for aneurysmal subarachnoid hemorrhage and intracerebral hemorrhage have been updated for the first time in years.Chinese expert consensuses have also been formulated to guide analgesia,sedation,and nutrition for neurocritical patients.In summary,encouraging progress has been achieved in the field of neurocritical care.However,more high-quality studies are still warranted in the future to inform the precise and personalized medicine.
作者
陈雨晴
王淑雅
张琳琳
周建新
Chen Yuqing;Wang Shuya;Zhang Linlin;Zhou Jianxin(Department of Critical Care Unit,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)
出处
《中国急救医学》
CAS
CSCD
2024年第1期30-37,共8页
Chinese Journal of Critical Care Medicine
关键词
神经重症
脑出血
脑梗死
颅脑损伤
蛛网膜下腔出血
心脏骤停
血管内治疗
去骨瓣减压
Neurocritical care
Intracerebral hemorrhage
Cerebral infarction
Traumatic brain injury
Subarachnoid hemorrhage
Cardiac arrest
Endovascular therapy
Decompressive craniectomy
