中枢神经系统在受到原发损伤后，触发缺血缺氧、水电解质和酸碱代谢紊乱、钙内流等一系列病理生理改变，从而导致神经继发性损伤。及时而准确地监测这些病理生理改变，对于减少继发性损伤、降低致残率和病死率有着重要的意义。随着生物医学工程技术的进步，诊治方案的依据已由宏观的体征和组织形态变化转入微观的细胞分子事件，由定时的收集检测进入实时动态监测，神经重症监护室（neurological intensive unit care，NICU）已进入床旁多元监测时代。本文旨在对近年来NICU引入的多种先进监测措施以及相关的临床护理进行简要概述。
［1］ Cecil S, Chen P M, Callaway S E, et al . Traumatic brain injury: advanced multimodal neuromonitoring from theory to clinical practice［J］. Crit Care Nurse,2011,31:25-36.
［3］ Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury［J］. J Neurotrauma,2007,24 Suppl 1:S1-106.
［4］ The Brain Trauma Foundation, The American Association of Neurological Surgeons, The Joint Section on Neurotrauma and Critical Care. Recommendations for intracranial pressure monitoring technology［J］. J Neurotrauma,2000,17:497-506.
［5］ Morton R, Lucas T H, 2nd Ko A, et al . Intracerebral Abscess Associated with the Camino(R) Intracranial Pressure Monitor: Case Report and Review of the Literature［J］. Neurosurgery,2011［Epub ahead of print］.
［6］ Stendel R, Heidenreich J, Schilling A, et al . Clinical evaluation of a new intracranial pressure monitoring device［J］. Acta Neurochir (Wien),2003,145:185-193.
［7］ Raynham M. Hemedex Pocket Reference Guide［M］. Codman & Shurtleff Inc. 2008.1
［9］ Saqqur M, Zygun D, Demchuk A. Role of transcranial Doppler in neurocritical care［J］. Crit Care Med,2007,35:S216-223.
［10］ Narotam P K, Burjonrappa S C, Raynor S C, et al . Cerebral oxygenation in major pediatric trauma: its relevance to trauma severity and outcome［J］. J Pediatr Surg,2006,41:505-513.
［11］ Stewart C, Haitsma I, Zador Z, et al . The new Licox combined brain tissue oxygen and brain temperature monitor: assessment of in vitro accuracy and clinical experience in severe traumatic brain injury［J］. Neurosurgery,2008,63:1159-1164.
［12］ Stevens W J. Multimodal monitoring: head injury management using SjvO2 and LICOX［J］. J Neurosci Nurs,2004,36:332-339.
［13］ Celie B, Boone J, Van Coster R, et al . Reliability of near infrared spectroscopy (NIRS) for measuring forearm oxygenation during incremental handgrip exercise［J］. Eur J Appl Physiol,2011［Epub ahead of print］.
［14］ Presciutti M, Schmidt J M, Alexander S. Neuromonitoring in intensive care: focus on microdialysis and its nursing implications［J］. J Neurosci Nurs,2009,41:131-139.
［15］ Tisdall M M, Smith M. Cerebral microdialysis: research technique or clinical tool［J］. Br J Anaesth,2006,97:18-25.
［16］ Timofeev I, Czosnyka M, Carpenter KL, et al . Interaction between brain chemistry and physiology after traumatic brain injury: impact of autoregulation and microdialysis catheter location［J］. J Neurotrauma,2011,28:849-860.
［17］ Peerdeman S M, Girbes A R, Vandertop W P. Cerebral microdialysis as a new tool for neurometabolic monitoring［J］. Intensive Care Med,2000,26:662-669.
［18］ Goodman J C, Robertson C S. Microdialysis: is it ready for prime time?［J］. Curr Opin Crit Care,2009,15:110-117.
［19］ Ungerstedt U, Rostami E. Microdialysis in neurointensive care［J］. Curr Pharm Des,2004,10:2145-2152.
［20］ Sahuquillo J, Vilalta A. Cooling the injured brain: how does moderate hypothermia influence the pathophysiology of traumatic brain injury［J］. Curr Pharm Des,2007,13:2310-2322.
PDF(725 KB)
