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首页> 外文期刊>The Canadian Journal of Neurological Sciences: le Journal Canadien des Sciences Neurologiques >Survey of management of severe head injury in Canada.
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Survey of management of severe head injury in Canada.

机译：加拿大严重颅脑损伤管理调查。

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OBJECTIVE: To determine: 1. the degrees of consensus and disagreement among Canadian critical care clinicians regarding the appropriateness (benefit exceeding risk) of common therapeutic manoeuvres in patients with severe closed head injury (CHI), and 2. the frequency with which clinicians employed these manoeuvres. METHODS: The study design was a systematic scenario-based survey of all neurosurgeons and critical care physicians treating patients with severe CHI in Canada. RESULTS: In the scenario of acute epidural hematoma with mass effect, respondents agreed very strongly that surgery was appropriate. Clinicians reported mannitol and hypertonic saline as appropriate. Beyond these two interventions, agreement was less strong, and the use of the extraventricular drain (EVD), phenytoin, cooling, hyperventilation, nimodipine, and jugular venous oximetry (JVO) were of uncertain appropriateness. Steroids were considered inappropriate. In a scenario of diffuse axonal injury (DAI), clinicians agreed stronglythat fever reduction, early enteral feeding, intensive glucose control, and cerebral perfusion pressure (CPP)-directed management were appropriate. The use of mannitol, hypertonic saline, EVD, JVO, narcotics and propofol were also appropriate. Neuromuscular blockade, surgery, and hyperventilation were of uncertain appropriateness. The appropriateness ratings of the interventions considered in the scenario of an intracranial contusion mirrored the DAI scenario. In general, correlations between the reported appropriateness and frequency of use of each intervention were very high. An exception noted was the use of the JVO. The correlation between CPP-guided therapy and the use of the EVD was weak. CONCLUSIONS: This survey has described current practice with regard to treatment of patients with severe CHI. Areas of variation in perceived appropriateness were identified that may benefit from further evaluation. Suggested priorities for evaluation include the use of osmotic diuretics, anticonvulsants, and intracranial manometry.
机译：目的：确定：1.加拿大重症监护临床医生对重度闭合性颅脑损伤（CHI）患者常见治疗手段的适当性（获益超过风险）的共识和分歧程度，以及2.临床医生使用的频率这些动作。方法：本研究设计是对所有治疗加拿大重度CHI患者的神经外科医师和重症监护医师进行的基于情景的系统调查。结果：在急性硬膜外血肿伴有大量效应的情况下，受访者非常同意手术是适当的。临床医生酌情报告了甘露醇和高渗盐水。除了这两种干预措施外，一致性还不太强，并且室外引流（EVD），苯妥英钠，降温，换气过度，尼莫地平和颈静脉血氧测定法（JVO）的使用不确定性。类固醇被认为是不合适的。在弥漫性轴索损伤（DAI）的情况下，临床医生强烈同意发烧减少，早期肠内喂养，强化葡萄糖控制和脑灌注压（CPP）指导的治疗是适当的。甘露醇，高渗盐水，EVD，JVO，麻醉剂和丙泊酚的使用也是合适的。神经肌肉阻滞，手术和过度换气的适用性尚不确定。在颅内挫伤情况下考虑的干预措施的适当性等级反映了DAI情况。一般而言，报告的适当性和每种干预措施的使用频率之间的相关性非常高。注意到的一个例外是JVO的使用。 CPP指导疗法与EVD使用之间的相关性较弱。结论：本调查描述了重度CHI患者的当前治疗方法。确定了适当程度可能有所不同的领域，这些领域可能需要进一步评估。建议的评估重点包括使用渗透性利尿剂，抗惊厥药和颅内测压法。

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