创伤性颅脑损伤急救进展

1、我国每年超我国每年超过过10万人死于创伤，其中有一半死于致命万人死于创伤，其中有一半死于致命的颅脑创伤。的颅脑创伤。500,000人；死亡人；死亡100,000nTraumatic brain injury is a major public health problem in the United States, affecting nearly 500,000 patients per year. Approximately 100,000 of these patients will die of their injury, and 90,000 will suffer a long-t

2、erm neurologic disability. This translates into a societal cost of $75100 billion per year for medical care and lost productivity .1000,000人；人；如何将各个不同治疗单位的零散经验，成就和教训集中起来，分析、归纳、整理，去除其中不真实不可靠的部分，形成一个规范化的重型颅脑外伤的救治方案？如何充分利用我国众多颅脑损伤病人这一庞大的目标样本，开展严格设计的临床随机对照研究，确认一些临床有应用价值的技术与药物，解决一些基础性难题，从而在世界范围内对颅脑损伤救治作出

3、贡献？这是我国神经外科医务人员在新世纪的一项重要任务（如何缩小差距？）。 减少CBF需求 护理干预重点：护理干预重点： (AANN Clinical Practice Guideline Series )n维持较低的颅内压或者降低颅内压（Maintaining or Decreasing ICP）n对顽固性颅高压有争议的处置（Controversial Treatments for Refractory Intracranial Hypertension）n维持足够的脑灌注压或者增加脑灌注压（Maintaining Adequate CPP or Increasing CPP）n多重监护（Mo

4、nitoring Modalities）n预防深静脉血栓（Preventing DVT）n充足的营养(Adequate Nutrition)n控制血糖（Glycemic Control）n防治癫痫（Preventing Seizures）降低颅内压降低颅内压对顽固性颅高压有争议的处置对顽固性颅高压有争议的处置维持足够的脑灌注压或增加脑灌注压维持足够的脑灌注压或增加脑灌注压Treatment Algorithm: Clinical Practice Guidelines for the Nursing Management of Adults with Severe TBIHEAD INJURY

5、 ALERT CARDnFor: _nIf I sustain a major head injury, please take me to a Level One or comparable trauma center, and follow the directions on the other side of this card.nIF I AM IN A COMA PLEASE FOLLOW THESE INSTRUCTIONS*: Insure an open airway, breathing, and circulation to maintain adequate oxygen

6、 and blood pressure for my brain. Do a CAT scan as soon as possible and have it evaluated by a neurosurgeon. If I am in a coma and my CT scan is abnormal, monitor my brain pressure. If possible, drain cerebrospinal fluid in order to relieve elevated brain pressure. Make sure my blood pressure and my brain pressure are balanced to insure that my brain receives adequate blood and oxygen.n*Derive