柳叶刀:影响1200万人,中国颅脑损伤救治能力进步飞速

2019-02-23 江基尧 健康报医生频道

颅脑创伤是中国的一大公共卫生问题。《中国颅脑创伤》(Traumatic Brain Injury in China) 一文近日在《柳叶刀-神经病学》在线发表。中国颅脑创伤治疗现状如何?此领域的研究重点在哪里?未来该走向哪里?我们邀请文章通讯作者、上海交通大学医学院附属仁济医院首席专家江基尧教授做解读。


颅脑创伤是中国的一大公共卫生问题。《中国颅脑创伤》(Traumatic Brain Injury in China) 一文近日在《柳叶刀-神经病学》在线发表。中国颅脑创伤治疗现状如何?此领域的研究重点在哪里?未来该走向哪里?我们邀请文章通讯作者、上海交通大学医学院附属仁济医院首席专家江基尧教授做解读

1颅脑创伤带来的问题不容小视

颅脑创伤(traumatic brain injury,TBI)是一种由外力引起的大脑功能的改变,在车祸、跌倒或其他事故后发生。

国外学者称该创伤每年直接影响约1200万人,它是导致中国人群死亡的重要因素,与颅脑创伤有关的死亡率逐年增加,2015年排名第5位。

与严重颅脑创伤相关的死亡率很高(超过30%),但即使是轻微颅脑创伤的幸存者也会有严重的身体和精神后遗症,这对患者及其家人的生活可能造成毁灭性的影响。可以说,颅脑创伤在中国是一个重大的公共卫生问题。

自21世纪以来,中国颅脑创伤发生率逐步得到控制,尤其是酒驾入刑以来,机动车交通事故有所减少。但是,中国遭受颅脑创伤的人数仍然很庞大,首要因素仍然是由交通事故导致的颅脑创伤,特别是因电动车急剧增加,且多在非机动车道行驶,导致颅脑创伤病人显著增加。另外,中国因老龄化导致的跌倒伤也明显增加,而且老年颅脑创伤死残率更高、救治效果相对也更差。

为了减少脑外伤的发生,还是建议继续加强机动车管理,加强安全宣传教育,特别是加大县级市和村镇机动车和安全教育管理。或将为颅脑创伤救治局面带来改变。

2救治后死亡率与欧美无差异

改革开放以来,特别是21世纪以来,中国颅脑创伤诊治方面取得长足进步。CT普及、循证医学实施、NICU建立和脑监测技术、专家共识和指南发布等,使得中国颅脑创伤临床救治整体水平达到国际先进水平。2013年启动的欧盟颅脑创伤研究计划CENTER-TBI项目,笔者作为中国负责人,采用欧盟统一CRF,完成了13,000多例前瞻性注册研究,初步分析结果表明中国与欧盟急性颅脑创伤死亡率无任何差异。

为了改善颅脑创伤患者的预后,医疗机构及医护工作者应在以下几方面改进:第一,加强空中转运,为及时抢救危重颅脑创伤伤员赢得宝贵时间。第二,加强各级医院创伤绿色通道、专用手术室和神经外科重症病房(NICU)的建设。第三,加强颅脑创伤诊治规范化。第四,普及严重颅脑创伤伤员颅内压监测技术。第五,加强颅内外并发症防治;第六,加强脑康复计划。

随着国家推动各级医院创伤中心建设、神经外科医师护士能力提高,以及颅脑创伤规范化救治水平提高,我国颅脑创伤死残率将进一步下降,造福广大颅脑创伤患者和家庭。

3走进国际舞台 力争更多突破

在颅脑创伤领域,中国研究者关注以下方面的研究。

第一是高质量多中心前瞻性随机对照研究(RCT)。目前,中国已经注册50多项颅脑创伤RCT研究。我们正在牵头进行的多中心RCT研究包括:多中心长时程亚低温治疗重型颅脑创伤患者是否降低死残率,早期正中神经电刺激给予是否对于创伤性昏迷病人有催醒作用。

第二是与国际同行合作,开展全球颅脑创伤临床研究。例如已经启动的CENTER-TBI项目(欧盟颅脑创伤研究计划)、TRACT-TBI项目(美国牵头的临床转化研究项目)等。

中国人口超过13.9亿,每年新增颅脑创伤病例数十万例,所以没有中国参加的全球临床研究是不完整的。正如我们的一篇关于颅脑创伤的重大报告 TBI Commission - Traumatic brain injury on integrated approaches to improve prevention, clinical care, and research所强调的那样,许多中国医院正在努力改善颅脑创伤患者的诊断和治疗,许多医院的神经外科都把主要的精力集中在TBI患者身上。在我们的一篇评论中强调需要可靠的流行病学数据,以指导预防战略、卫生保健的提供和临床研究重点。中国研究人员目前正在参与有关TBI的重要国际合作研究。中国可以在几年内成为TBI疗效比较研究领域的领导者。

(文/上海交通大学医学院附属仁济医院首席专家、上海市颅脑创伤研究所所长 江基尧)

作者简介

江基尧教授、主任医师、博士生导师。上海交通大学医学院附属仁济医院首席专家、上海市颅脑创伤研究所所长。世界神经外科医师联盟(WFNS)执委、国际神经创伤协会前任主席、亚太神经创伤协会候任主席、中华医学会创伤学分会主任委员、中国医师协会神经外科医师分会副会长、世界华人神经外科学会颅脑创伤专业委员会主任委员。牵头制订发表《中国颅脑创伤外科手术指南》等12个专家共识

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    2021-02-04 Doctoryangbai

    学习了

    0

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    2019-02-23 一天没事干

    很好的学习机会

    0

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    2019-02-23 龙胆草

    学习谢谢分享

    0

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    2019-02-23 yjs木玉

    好好好好好好

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=922883, encodeId=a4e792288382, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLyXfB3bOYOsDt885AsrYWhiaRtRdPh9aZlXugm7XErBVXusv5fJLIKWTicmjSQcOibDiaLzE2YMD44PA/132, createdBy=49f71976501, createdName=Doctoryangbai, createdTime=Thu Feb 04 21:41:27 CST 2021, time=2021-02-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1379960, encodeId=1a4b13e996059, content=<a href='/topic/show?id=5f3c10046499' target=_blank style='color:#2F92EE;'>#颅脑损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100464, encryptionId=5f3c10046499, topicName=颅脑损伤)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2bcd469, createdName=fengting3, createdTime=Sun Feb 24 15:11:00 CST 2019, time=2019-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1397716, encodeId=7466139e716a2, content=<a href='/topic/show?id=8bee565436d' target=_blank style='color:#2F92EE;'>#损伤#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=56543, encryptionId=8bee565436d, topicName=损伤)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eoNX3lUOlDKGBUEPNwZx0nibmdcFyeibnX4WMhUSCU2REpGRWtSmnT2CCs0dA5waxvJknYDxwtYnIcQ/132, createdBy=294e2500218, createdName=ms3046638856685384, createdTime=Sun Feb 24 15:11:00 CST 2019, time=2019-02-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=361335, encodeId=8537361335eb, content=很好的学习机会, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2018/04/12/cd30eefc465f70dc4dad89bd57479781.jpg, createdBy=02be2318568, createdName=一天没事干, createdTime=Sat Feb 23 10:17:20 CST 2019, time=2019-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=361330, encodeId=53f13613304a, content=学习谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Sat Feb 23 08:37:35 CST 2019, time=2019-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=361328, encodeId=4ce636132817, content=好好好好好好, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/08/29/bbc5cc0eed9b8d17623d2fd49dbdf19a.jpg, createdBy=79522135794, createdName=yjs木玉, createdTime=Sat Feb 23 08:05:09 CST 2019, time=2019-02-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=361312, encodeId=b2903613128d, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eqYPFHuMA3bhYQrHvycmum7IJoCsLK0FP6X56Eoj9PZAECDke8zLCKxZZvk9q7B6rZmPuFgN5YCfw/132, createdBy=f52d2514454, createdName=SCI我的梦, createdTime=Sat Feb 23 07:17:21 CST 2019, time=2019-02-23, status=1, ipAttribution=)]
    2019-02-23 SCI我的梦

    谢谢分享

    0