2017年10月16日，美国神经重症监护学会（Neurocritical Care Society，NCS）发布了目标温度管理（targeted temperature management，TTM）实施循证指南（以下称2017 NCS指南）。指南编辑委员会基于人群-干预-比较-结果（population-intervention-comparison-outcome，PICO），针对TTM的诱发和维持、寒战和并发症这3个方面、共16个相关临床问题进行了阐述与讨论。2017 NCS指南旨在协助采用TTM手段进行监护的神经重症监护医师更好地开展TTM。同时，本文在对2017 NCS指南进行解读的基础上，将该指南与2017年法国重症监护室TTM指南、2015年加拿大心脏骤停后TTM指南、2016年中国心脏骤停后目标温度管理专家共识和2015年神经重症低温治疗中国专家共识进行比较和分析，以帮助临床医师更好地了解TTM在神经重症监护中的应用进展。
Abstract
On October 16, 2017, the Neurocritical Care Society (NCS) released an evidence-based guideline: The Implementation of Targeted Temperature Management (TTM) (hereinafter referred to as the 2017 NCS guideline). Based on population-intervention-comparison-outcome (PICO) frame, the editorial committee for this guide line has addressed and discussed 16 clinical problems related to the 3 aspects of implementation of TTM in neurocritical care practice, including TTM’s induction and maintenance, shivering and complications. The 2017 NCS guideline is designed to assist the clinicians in neurocritical care who use TTM to carry out TTM better. Based on the interpretation of the 2017 NCS guideline, the similarities and differences in TTM application among the 2017 NCS guideline, 2017 guidelines for TTM in the intensive care unit (ICU) from France, 2015 guidelines for the use of TTM (therapeutic hypothermia) after cardiac arrest from Canada, 2016 China expert consensus on TTM after cardiac arrest and 2015 China expert consensus on hypothermia in neurocritical care are analyzed and compared, in order to help clinicians better understand the TTM application in neurocritical care.
关键词
神经重症监护 /
目标温度管理 /
寒战 /
新陈代谢 /
并发症 /
指南 /
神经重症监护学会
Key words
Neurocritical care /
Targeted temperature management /
Shivering /
Metabolism /
Complications /
Guideline /
Neurocritical Care Society
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] MADDEN LK, HILL M, MAY TL, et al. The implementation of targeted temperature management: an evidence-based guideline from the Neurocritical Care Society[J]. Neurocrit Care, 2017, 27(3):468-487.
[2] CARIOU A, PAYEN JF, ASEHNOUNE K, et al. Targeted temperature management in the ICU: guidelines from a French expert panel[J/OL]. Ann Intensive Care, 2017, 7(1):70(2017-06-19)[2017-11-21]. https://doi.org/10.1186/s13613-017-0294-1.
[3] HOWES D, GRAY SH, BROOKS SC, et al. Canadian Guidelines for the use of targeted temperature management (therapeutic hypothermia) after cardiac arrest: A joint statement from The Canadian Critical Care Society (CCCS), Canadian Neurocritical Care Society (CNCCS), and the Canadian Critical Care Trials Group (CCCTG). Resuscitation, 2015, 98:48-63.
[4] 心脏骤停后目标温度管理共识专家组. 心脏骤停后目标温度管理专家共识[J]. 中华急诊医学杂志, 2016, 25(8):1000-1006.
[5] 中华医学会神经病学分会神经重症协作组. 神经重症低温治疗中国专家共识[J]. 中华神经科杂志, 2015, 48(6):453-458.
基金
浦东新区卫生和计划生育委员会卫生计生科研项目浦东新区重点学科中西医结合神经内科（编号：PWZxk2017-04）；上海市第七人民医院人才培养计划（编号：MZY2017-01）
PDF(2217 KB)
