摘要
颅脑损伤(TBI)致残、致死率较高,严重威胁国人健康。在TBI患者的救治过程中,及时有效的院前急救和处置是降低TBI致残、致死率,提高救治水平的关键环节。我国目前的院前急救主要是由"120"急救中心人员和现场非专业人员共同完成,院前急救人员TBI专业救治知识及经验储备不足,TBI患者不能得到及时专业有效的救治是制约我国TBI救治水平提高的重要原因之一。本文将对和平时期交通伤、坠落伤等所致TBI的院前评估、治疗和转运综述如下。
Traumatic brain injury(TBI) is a serious threat to the health of Chinese people because of its high rate of the disability and morality. In the treatment of TBI patients, timely and effective pre-hospital treatment is the key link to reduce the disability and mortality of the TBI and improve the treatment level. The current pre-hospital treatment in China is mainly completed by "120" emergency center personnel and on-site non-professional personnel. The professional knowledge and experience reserve of pre-hospital emergency personnel for brain trauma treatment are insufficient, and the failure of TBI patients to receive timely, professional and effective treatment is one of the important reasons restricting the improvement of TBI treatment level in China. In this paper, the pre-hospital assessment, treatment and transport of the TBI patients caused by peacetime traffic injury and falling injury are summarized as follows.
引文
[1]Sulhan S,Lyon KA,Shapiro LA,et al.Neuroinflammation and blood-brain barrier disruption following traumatic brain injury:pathophysiology and potential therapeutic targets[J].J Neurosci Res,2018,Epub ahead of print.
[2]Maas AIR,Menon DK,Adelson PD,et al.Traumatic brain injury:integrated approaches to improve prevention,clinical care,and research[J].Lancet Neurol,2017,16(12):987-1048.
[3]Hyder AA,Wunderlich CA,Puvanachandra P,et al.The impact of traumatic brain injuries:a global perspective[J].NeuroRehabilitation,2007,22(5):341-353.
[4]Berge LR.Health care emergency management:principles and practice[J].JAMA,2011,305(2):203-204.
[5]张小年,张皓.创伤性颅脑损伤国内研究进展[J].中国康复理论与实践,2008,14(2):101-104.
[6]Lerner EB,Moscati RM.The golden hour:scientific fact or medical“urban legend”[J].Acad Emerg Med,2001,8(7):758-760.
[7]Vella MA,Crandall ML,Patel MB.Acute management of traumatic brain injury[J].Surg Clin North Am,2017,97(5):1015-1030.
[8]Chesnut RM,Marshall LF,Klauber MR,et al.The role of secondary brain injury in determining outcome from severe head injury[J].J Trauma,1993,34(2):216-222.
[9]Badjatia N,Carney N,Crocco TJ,et al.Guidelines for prehospital management of traumatic brain injury 2nd edition[J].Prehosp Emerg Care,2008,12 Suppl 1:S1-S52.
[10]Boer C,Franschman G,Loer SA.Prehospital management of severe traumatic brain injury:concepts and ongoing controversies[J].Curr Opin Anaesthesiol,2012,25(5):556-562.
[11]Teasdale G,Jennett B.Assessment of coma and impaired consciousness:a practical scale[J].Lancet,1974,2(7872):81-84.
[12]Timmons SD,Bee T,Webb S,et al.Using the abbreviated injury severity and Glasgow Coma Scale scores to predict 2-week mortality after traumatic brain injury[J].J Trauma,2011,71(5):1172-1178.
[13]Healey C,Osler TM,Rogers FB,et al.Improving the Glasgow Coma Scale score:motor score alone is a better predictor[J].JTrauma,2003,54(4):671-678,discussion 678-680.
[14]Ross SE,Leipold C,Terregino C,et al.Efficacy of the motor component of the Glasgow Coma Scale in trauma triage[J].JTrauma,1998,45(1):42-44.
[15]Pakkanen T,Virkkunen I,K覿m覿r覿inen A,et al.Pre-hospital severe traumatic brain injury-comparison of outcome in paramedic versus physician staffed emergency medical services[J].Scand J Trauma Resusc Emerg Med,2016,24(1):62.
[16]Jeevaratnam DR,Menon DK.Survey of intensive care of severely head injured patients in the United Kingdom[J].BMJ,1996,312(7036):944-947.
[17]Rowell SE,Fair KA,Barbosa RR,et al.The impact of prehospital administration of lactated ringer’s solution versus normal saline in patients with traumatic brain injury[J].J Neurotrauma,2016,33(11):1054-1059.
[18]Qureshi AI,Wilson DA,Traystman RJ.Treatment of elevated intracranial pressure in experimental intracerebral hemorrhage:comparison between mannitol and hypertonic saline[J].Neurosurgery,1999,44(5):1055-1063,discussion 1063-1064.
[19]Francony G,Fauvage B,Falcon D,et al.Equimolar doses of mannitol and hypertonic saline in the treatment of increased intracranial pressure[J].Crit Care Med,2008,36(3):795-800.
[20]Ichai C,Armando G,Orban JC,et al.Sodium lactate versus mannitol in the treatment of intracranial hypertensive episodes in severe traumatic brain-injured patients[J].Intensive Care Med2009,35(3):471-479.
[21]Kou K,Hou XY,Sun JD,et al.Current pre-hospital traumatic brain injury management in China[J].World J Emerg Med,2014,5(4):245-254.
