多模态脑监测在动脉瘤性蛛网膜下腔出血中的应用研究进展  

Research Progress in the Application of Brain Multimodal Monitoring in Aneurysmal Subarachnoid Hemorrhage

作　　者：李伊璠 刘波[1] 李晓鹏[1] LI Yifan;LIU Bo;LI Xiaopeng(Department of Critical Care Medicine,the First Affiliated Hospital of Xinjiang Medical University,Urumqi Xinjiang 830000 China)

机构地区：[1]新疆医科大学第一附属医院重症医学科,新疆乌鲁木齐830000

出　　处：《中国卫生标准管理》2025年第4期194-198,共5页China Health Standard Management

基　　金：新疆神经系统疾病研究重点实验室开放课题(XJDX1711-2209)。

摘　　要：神经重症监护室(neuro-intensive care unit,NICU)患者多存在继发性脑损伤,因此预防、诊断及治疗继发性脑损伤是影响患者临床转归的重要因素。神经系统的常规检查不足以及时检测继发性脑损伤的发生,从而使患者失去最佳的治疗时机。近年来,多模态脑监护(brain multimodal monitoring,MMM)成为NICU临床决策的重要工具,其采用多种监护手段,全方位、多角度评估脑生理功能和病理改变。如大多数发达国家的神经重症监护病房都有颅内压(intracranial pressure,ICP)和脑灌注压(cerebral perfusion pressure,CPP)监测,以及经颅多普勒(transcranial Doppler,TCD)及脑电图(electroencephalography,EEG)等作为脑部监测工具。MMM对NICU患者病情变化的预测非常重要,目前已经开发了多种神经监测技术来评估不同角度脑的生理及病理改变,如脑组织氧监测、ICP及CPP监测、脑代谢监测、脑血流监测、脑电波监测等。文章综述讨论了当前常用的神经危重症监测工具。MMM用于神经重症患者的治疗是当前的新趋势,可帮助临床医生全面评估患者的病情进展,以期实现精细化管理,从而改善患者的远期预后。但目前,MMM对于继发性脑损伤的预测尚缺乏大规模的临床验证,所以需要进一步研究来证明MMM在神经危重症患者中的应用。Patients are secondary brain injury in neuro-intensive care unit(NICU),so the prevention,diagnosis and treatment of secondary brain injury are important factors affecting the clinical outcome of patients.Routine examination of the nervous system is insufficient to detect the occurrence of secondary brain injury in time,thus losing the optimal treatment opportunity for patients.In recent years,brain multimodal monitoring(MMM)has become an important tool for clinical decision-making in NICU.It adopts a variety of monitoring methods to assess brain physiological function and pathological changes from all directions and angles. For example, neurological intensive care units in most developed countries have intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring, as well as transcranial Doppler (TCD) and electroencephalography (EEG) as brain monitoring tools. MMM is very important to predict the disease changes of NICU patients. At present, various neuromonitoring techniques have been developed to evaluate the physiological and pathological changes of the brain from different angles, such as brain tissue oxygen monitoring, ICP and CPP monitoring, brain metabolism monitoring, cerebral blood flow monitoring, brain electrical monitoring, etc. This review discusses current commonly used neurocritical illness monitoring tools. MMM for the treatment of neurosevere patients is a new trend, which helps clinicians comprehensively evaluate the progression of patients in the hope to achieve fine management and thus improve the long- term prognosis of patients. However, at present, large-scale clinical validation of MMM prediction for secondary brain injury is lacking, so further studies are needed to prove the application of MMM in neurocritically ill patients.

关 键 词：神经重症医学 多模态脑监测 动脉瘤性蛛网膜下腔出血 脑氧合 脑血流量 颅内压监测 量化脑电图 综述 

分 类 号：R743[医药卫生—神经病学与精神病学]