摘要
神经重症监护室(NICU)患者多存在继发性损伤,如脑水肿、颅高压、癫痫及灌注异常,因此,预防、诊断及治疗继发性脑损伤是影响患者临床转归和结局的重要因素。多模态脑监护(MMM)采用多种监护手段,系统性、全面性评估脑生理功能和病理改变,以期实现精准化管理。目前常用的MMM技术包括脑组织氧监测、颅内压监测、脑代谢监测、脑血流监测、脑电监测和多模态影像学,并可分为有创性和无创性,这些监测技术可评估不同角度的脑生理及病理改变。近红外光谱(NIRS)可用于脑组织血氧饱和度,评估颅内灌注情况及血管调节功能。有创颅内压监测可精准监测患者颅内压变化,预测颅内压变化,指导脱水降颅压药物用量。脑微透析(CMD)可对颅内细胞外液进行采样,实时监测颅内代谢产物含量,明确颅内代谢情况。经颅多普勒超声(TCD)可用于监测颅内外大血管的血流量。脑电监测可直接反映脑电活动,也可间接反映脑血流量,用于预测继发性损伤中癫痫及脑缺血情况,而其中的连续脑电图(cEEG)监测在神经重症中应用较为多见,脑电波形的改变与患者临床症状及预后密切相关。多模态影像学作为新兴的监测技术,可客观反映脑结构、功能及病理改变。该文系统梳理了目前应用于NICU中MMM的各类监测技术的应用原理及监测特点,归纳总结了不同监测技术指标与临床预后的相关性,并浅谈这些监测技术目前存在的问题和挑战。
Patients with severe neurological diseases in the neuroscience intensive care unit(NICU)often suffer from various secondary injuries,such as cerebral edema,intracranial hypertension,epilepsy,and abnormal perfusion,and therefore,the prevention,diagnosis,and treatment of secondary brain injury are important influencing factors for clinical prognosis and outcome.Brain multimodal monitoring(MMM)uses various methods to systematically and comprehensively evaluate the physiological function and pathological changes of the brain,so as to realize precise management.At present,commonly used MMM techniques include brain tissue oxygen monitoring,intracranial pressure monitoring,cerebral metabolism monitoring,cerebral blood flow monitoring,electroencephalographic monitoring,and multimodal neuroimaging,which can be classified as invasive and noninvasive techniques,and these monitoring techniques can evaluate pathological and physiological changes of the brain from different perspectives.Near-infrared spectroscopy(NIRS)can be used to evaluate blood oxygen saturation in brain tissue,intracranial perfusion,and the regulatory function of vessels.Invasive intracranial pressure monitoring can accurately monitor and predict the change in intracranial pressure and guide the amount of drugs used for dehydration and reducing intracranial pressure.Cerebral microdialysis(CMD)can perform sampling of intracranial extracellular fluid and monitor the content of intracranial metabolites to clarify intracranial metabolism.Transcranial Doppler(TCD)can be used to monitor the blood flow volume of intracranial and extracranial major blood vessels.Electroencephalographic monitoring can reflect brain electrical activity directly and cerebral blood flow indirectly and is used to predict epilepsy and cerebral ischemia;continuous electroencephalographic(cEEG)monitoring is often used in severe neurological diseases,and the change in brain waves is closely associated with clinical symptoms and prognosis.As an emerging technique,multimodal neuroimaging can objectively reflect the structural,functional,and pathological changes of the brain.This article introduces the application principles and monitoring characteristics of each MMM technique currently used in the NICU,summarizes the association of different monitoring indicators with clinical prognosis,and discusses existing problems and challenges in these techniques.
作者
刘田田
刘恒方
LIU Tian-Tian;LIU Heng-Fang(Department of Neurology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China;Department of Neurology,the Fifth Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)
出处
《国际神经病学神经外科学杂志》
2022年第6期92-96,共5页
Journal of International Neurology and Neurosurgery
基金
国家自然科学基金(81901326)
河南省医学科技攻关计划项目(2018020066)。
关键词
神经系统疾病
神经重症医学
多模态脑监测
脑电监测
多模态神经影像学
nervous system diseases
neurocritical medicine
brain multimodal monitoring
electroencephalographic monitoring
multimodal neuroimaging
作者简介
刘田田(1988-),女,主治医师,主要从事癫痫及神经重症的研究。Email:liutt1216@126.com;通信作者:刘恒方(1965-),男,教授,主要从事脑血管病及神经电生理的研究。Email:liuhf1965@163.com。
