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对严重脑损害病人施行的早期经喉气管造口术

德国医学 2001年第5期18卷 263-265页

作者： N.stocchetti A.Parma V.Songa A.Colomperti L.Tongnini 刘喆隆 Department Anesthesia and Intensive Care Neuroscience Intensive Care.Policlin-ico Hospital IRCCS Via Francesco Sforza 3520122 MilanItaly 华中科技大学同济医学院附属协和医院

作为对严重脑损害的处理的一个环节,气管造口术对于减少肺部损害是必要的;并且能缩短患者在重症监护病房(ICU)以及住院的时间.因为颅脑损害后,咳嗽、呕吐等气道保护性反射常丧失,为了延长通气支持以及保护气道,可施行气管造口术.越来越...

作为对严重脑损害的处理的一个环节,气管造口术对于减少肺部损害是必要的;并且能缩短患者在重症监护病房(ICU)以及住院的时间.因为颅脑损害后,咳嗽、呕吐等气道保护性反射常丧失,为了延长通气支持以及保护气道,可施行气管造口术.越来越多地使用新的方法(如在内镜引导下经皮扩张气管造口术),作为除标准外科气管造口术之外的选择.经喉气管造口术(TLT)在最近受到推崇,这种可进一步扩张气道的方法显得安全而简便.然而像纤维支气管镜检或气道插管抽吸这样的操作导致神经系统并发症的风险大,对于颅内高压的患者更是如此.因为颅内血流量的增加会导致颅内压的显著升高,并可能导致脑灌注压(CPP)的减少,所以颅内补偿机制衰竭的患者具有较高的危险.

关键词：脑损伤早期经喉气管造口术

发热对急性脑损伤患者神经化学和脑组织氧代谢的影响

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世界核心医学期刊文摘（神经病学分册） 2005年第11期1卷 40-40页

作者： stocchetti N. Protti A. Lattuada M. N. stocchetti 史焕昌 Prof. Terapia Intensiva Neuroscienze Ospedale Policlinico IRCCS Milano Padiglione Beretta Neuro Via F Sforza 35 20122 Milan Italy

Background: Postischaemic pyrexia exacerbates neuronal damage. Hyperthermia related cerebral changes have still not been well investigated in humans. Objective: To study how pyrexia affects neurochemistry and cerebral oxygenation after acute brain injury. Methods: 18 acutely brain injured patients were studied at the onset and resolution of febrile episodes (brain temperature ≥38.7°C). Intracranial pressure (ICP), brain tissue oxygen tension (PbrO2)/ and brain tissue temperature (Tbr)were recorded continuously; jugular venous blood was sampled intermittently. Microdialysis probes were inserted in the cerebral cortex and in subcutaneous tissue. Glucose, lactate, pyruvate, and glutamate were measured hourly. The lactate to pyruvate ratio was calculated. Results: Mean (SD) Tbr rose from 38 (0.5) to 39.3 (0.3) °C. Arteriojugular oxygen content difference (AJDO2) fell from 4.2 (0.7) to 3.8 (0.5) vol%(p 0.05) and PbrO2 rose from 32 (21) to 37 (22) mm Hg (p 0.05). ICP increased slightly and no significant neurochemical alterations occurred. Opposite changes were recorded when brain temperature returned towards baseline. Conclusions: As long as substrate and oxygen delivery remain adequate, hyperthermia on its own does not seem to induce any further significant neurochemical alterations. Changes in cerebral blood volume may, however, affect intracranial pressure.

关键词：急性脑损伤氧代谢颈静脉氧饱和度神经化学颈静脉血变化机制乳酸盐神经损伤丙酮酸盐消退期

动脉瘤性蛛网膜下腔出血患者的重症监护处理：神经危重症监护学会多学科共识会议的推荐意见

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国际脑血管病杂志 2013年第5期21卷 324-347页

作者： Michael N. Diringer Thomas P. Bleck J. Claude Hemphill David Menon Lori Shutter Paul Vespa Nicolas Bruder E. Sander Connolly Jr Giuseppe Citerio Daryl Gress Daniel Hanggi Brian L. Hoh Giuseppe Lanzino Peter Le Roux Alejandro Rabinstein, Erich Schmut zhard Nino stocchetti Jose I. Suarez Miriam Tresgiari Ming-Yuan Tseng Mervyn D. I. Vergouwen Stefan Wolf Gregory Zip fel 田飞(译) 宿英英(译) From the Neurology/Neurosurgery Intensive Care Unit Washingion University St. Louis MO USA Rush Medical College Chicago IL USA University of California at San Francisco San Francisco CA USA University of Cambridge Cambridge UK University of Cincinnati Cincinnati OH USA University of California at Los Angeles LOs Angeles CA USA Universit6 de la M.diterranae Marsedle France Columbia University New York NY USA San Gerardo Hospital Monza Italy University of Virginia Charlottesville VA USA Heinrich-Heine University Dttsseldorf Germany University of Florida Gainesville FL USA Mayo Clinic Rochester MN USA University of Pennsylvania Philadelphia PA USA University Hospital Innsbruck lnnsbruck Austria Fondazione IRCCS Ch Granda- Ospedale Policlinico Milan University Milan Italy University of Washington St. Louis MO USA Baylor College of Medicine Houston TX USA Nottingham University Hospitals Nottingham UK University of Utrecht Utrecht The Netherlands Freie Universitit Berlin Berlin Germany Washington University St. Louis MO USA 首都医科大学宣武医院神经内科北京100053

蛛网膜下腔出血（subarachnoidhemorrhage，SAH）是一种可对中枢神经系统造成毁灭性打击并对其他多个器官产生显著影响的急性脑血管病。SAH患者被常规收入重症监护病房并由多学科团队进行治疗。由于高质量研究证据的缺乏，使得治疗方法...

蛛网膜下腔出血（subarachnoidhemorrhage，SAH）是一种可对中枢神经系统造成毁灭性打击并对其他多个器官产生显著影响的急性脑血管病。SAH患者被常规收入重症监护病房并由多学科团队进行治疗。由于高质量研究证据的缺乏，使得治疗方法各异，可供选择的指导意见不多。现有的指南主要强调危险因素、预防、自然史以及再出血的预防，很少涉及SAH患者的重症监护问题。美国神经危重症监护学会组织了一次国际性多学科共识会议来探讨SAH的重症监护处理。根据发表的文章和研究领域，此次会议召集了来自欧洲和北美地区的神经重症监护科、神经外科、神经内科、介入神经放射科和神经麻醉科方面的专家。根据临床经验和制定实践指南方面的经验，选择4名经验丰富的神经重症监护专家组成评判委员会。应用推荐分级的评估、制定与评价（GradesofRecommendationsAssessment，DevelopmentandEvaluation，GRADE）系统进行文献回顾，结合参会者的经验、评判委员会的审评以及文献讨论产生推荐意见。应用GRADE系统制定推荐意见，其制定原则不仅强调研究资料的质量，而且还重视利弊权衡与实践转化。对SAH患者日常处理过程中面临的所有问题均提供指导和推荐意见，即使缺乏高质量的证据。

关键词：蛛网膜下腔出血重症监护动脉瘤血管痉挛抗惊厥药低钠血症血管内发热

神经重症监护患者的液体治疗:ESICM专家共识及临床实践推荐

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国际脑血管病杂志 2019年第2期27卷 84-97页

作者： Mauro Oddo Daniele Poole Raimund Helbok Geert Meyfroidt Nino stocchetti Pierre Bouzat Maurizio Cecconi Thomas Geeraerts Ignacio-Martin Loeches Herve Quintard Fabio Silvio Taccone Romergryko G. Geocadin Claude Hemphill Carole Ichai David Menon Jean-Francois Payen Anders Perner Martin Smith Jose Suarez Walter Videtta Elisa R. Zanier Giuseppe Citerio 何毅华(译) 常远(译) 王晓蔷(译) 潘速跃(译) Department of Medic al-Surgical Intensive Care Medicine Faculty of Biology and Medicine Centre Hospitalier Universitaire VauDOIs (CHUV) Lhiversity of Lausanne Rue du Bugnon 46 B4 08.623 1011 Lausanne Switzerland Department of Intensive Care Medicine St James's Lhiversity Hospital James's St Ushers P.O. Box 580 Dublin & Ireland Service de Reanimation Medic o-chirurgic ale Hopital Pasteur 2 UniversiteCote d'Azur CHU de Nice 06000 Nice France Unite CNRS 7275 Sophia-Antipolis France Department of Intensive Care Erasme Hospital University Libre de Bruxelles Brussels Belgium Neurosciences Critical Care Departments of Anesthesiology and Critical Care Medicine Neurology and Neurosurgery Johns Hopkins Lhiversity Baltimore MD USA Department of Neurology University of California San Francisco San Francisco CA LKA Service de Reanimation Polyvalente Hopital Pasteur 2 CHU de Nice 30 Voie Romaine CS 51069 06001 Nice Cedex 1 France Division of Anaesthesia University of Cambridge Addenbrooke's Ffospital Box 93 Hfills Road Cambridge Cambridgeshire CB2 2QQ UK Department of Intensive Care 4131 Copenhagen University Hospital- Rigshospitalet Copenhagen Denmark Department of Neuroanesthesia and Neurocritic al Care The National Ffospital for Neurosurgery and Neurology Lhiversity College London Hospitals London UK Anesthesia and Intensive Care Operative th it S. Martino Hospital Belluno Italy Hospital Nacional Professor Alejandro Posadas Buenos Aires Argentina Department of Neurosciences IRCCS-Istituto di Ricerche Farmacotogiche Mario Negri Milan Italy School of Medicine and Surgery University of Milan-Bicocca Milan Italy Neurointensive Care San Gerardo Hospital ASST-Monza 20900 Monza Italy 南方医科大学南方医院神经内科广州510515 Neurological Intensive Care Lhit Department of Neurology Medical University of Innsbruck Innsbruck Austria Department of Intensive Care Medicine University Hospitals Leuven Louvain Belgium Neuroscience Intensive Care Unit Department of Anesthesia and C

目的发布欧洲重症医学学会(European Society of Intensive Care Medicine, ESICM)关于神经重症监护患者液体治疗的专家共识和临床实践推荐意见。设计在2016年10月召开的ESICM LIVE 2016会议上召集了一个由22名国际专家组成的共识委员会...

目的发布欧洲重症医学学会(European Society of Intensive Care Medicine, ESICM)关于神经重症监护患者液体治疗的专家共识和临床实践推荐意见。设计在2016年10月召开的ESICM LIVE 2016会议上召集了一个由22名国际专家组成的共识委员会,随后委员会成员通过电话会议和在线讨论制定本专家共识。方法回顾人群、干预、对比和结局(population, intervention,comparison, and outcomes, PICO)问题,根据需要进行更新并得到证据概要。本共识关注3个主要议题:(1)神经重症监护患者的液体复苏和维持;(2)高渗液体在颅内压控制中的应用;(3)蛛网膜下腔出血后迟发性脑缺血的液体管理。经过广泛的文献检索,应用推荐分级的评估、制订与评价(Gradingof Recommendations Assessment, Development and Evaluation, GRADE)系统原则评估证据质量(从高到极低),制定治疗推荐(强或弱),并在适用时发布最佳实践声明。基于文献和专家意见提供的综合证据,应用改良德尔菲方法(使用序贯方法以避免偏倚和误解)产生最终共识声明。结果最终共识包含总共32条声明,其中13条为强推荐,17条为弱推荐,另外2条声明未提供推荐意见。结论我们发布了一份关于神经重症监护患者液体治疗的共识声明和临床实践推荐。

关键词：循证医学指南液体治疗创伤性脑损伤蛛网膜下腔出血脑出血卒中甘露醇高渗神经重症监护