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Good Preanesthetic Evaluation Is a Prelude to Good Surgical Outcome—But Where Are the Guidelines? 良好的麻醉前评估是良好手术效果的前奏——但指南在哪里?
Q4 ANESTHESIOLOGY Pub Date : 2022-06-01 DOI: 10.1055/s-0042-1751242
G. S. Rao
a of clinical assessment laboratory the administra-tion of for an important component of the anesthetic management of a The perioperative on the various domains of a ’ nature of surgery. func-tion by the of PAE aims the risk – bene fi t PAE provides an In elective for optimization fi the
临床评估实验室的管理是麻醉管理的重要组成部分。围手术期各领域的手术性质。PAE函数的目标是风险-收益,PAE为优化模型提供了一个选择
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引用次数: 0
Concomitant Pneumocephalus and Pneumorrhachis after Posterior Fossa Surgery 后Fossa术后并发肺炎和肺出血
Q4 ANESTHESIOLOGY Pub Date : 2022-05-30 DOI: 10.1055/s-0042-1744394
Sameera Vattipalli, Mayank Tyagi, C. Mahajan, A. Chaturvedi
Pneumorrhachis, the presence of air in the spinal canal, may be caused by diverse pathologies such as incidental durot-omy, barotrauma, pneumothorax, and trauma. 1 It is usually asymptomatic, being often noted on radiological investiga-tions, but at times can cause features of cord compression. 2 The occurrence of pneumocephalus is quite common after posterior fossa surgery, but pneumorrhachis is a rare entity despite an existing communication between the cerebral and spinal subarachnoid spaces. We report a case of pneumorrhachis, wherein air was incidentally detected on postoperative scans in a child after posterior fossa surgery. Parent of this child provided written consent for the publication of this letter. A
气胸,即椎管中存在空气,可由多种病理引起,如偶发性硬膜切开、气压创伤、气胸和创伤。它通常是无症状的,经常在放射学调查中被注意到,但有时会引起脐带压迫的特征。2后颅窝手术后发生脑气是很常见的,但尽管脑和脊髓蛛网膜下腔之间存在通信,但气腹是一种罕见的实体。我们报告一例肺气炎,其中空气是偶然发现在术后扫描的儿童后窝手术。该孩子的父母为这封信的发表提供了书面同意。一个
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引用次数: 0
A Narrative Review on Translational Research in Acute Brain Injury 急性脑损伤转译研究述评
Q4 ANESTHESIOLOGY Pub Date : 2022-05-05 DOI: 10.1055/s-0042-1744399
C. Mahajan, I. Kapoor, H. Prabhakar
There has been a constant endeavor to reduce the mortality and morbidity associated with acute brain injury. The associated complex mechanisms involving biomechanics, markers, and neuroprotective drugs/measures have been extensively studied in preclinical studies with an ultimate aim to improve the patients' outcomes. Despite such efforts, only few have been successfully translated into clinical practice. In this review, we shall be discussing the major hurdles in the translation of preclinical results into clinical practice. The need is to choose an appropriate animal model, keeping in mind the species, age, and gender of the animal, choosing suitable outcome measures, ensuring quality of animal trials, and carrying out systematic review and meta-analysis of experimental studies before proceeding to human trials. The interdisciplinary collaboration between the preclinical and clinical scientists will help to design better, meaningful trials which might help a long way in successful translation. Although challenging at this stage, the advent of translational precision medicine will help the integration of mechanism-centric translational medicine and patient-centric precision medicine.
人们一直在努力降低与急性脑损伤相关的死亡率和发病率。相关的复杂机制涉及生物力学、标志物和神经保护药物/措施,已在临床前研究中广泛研究,最终目的是改善患者的预后。尽管做出了这样的努力,但只有少数成功地转化为临床实践。在这篇综述中,我们将讨论将临床前结果转化为临床实践的主要障碍。需要选择合适的动物模型,牢记动物的种类、年龄和性别,选择合适的结果测量方法,确保动物试验的质量,并在进行人体试验之前对实验研究进行系统的回顾和荟萃分析。临床前和临床科学家之间的跨学科合作将有助于设计更好的、有意义的试验,这可能有助于成功的翻译。虽然现阶段具有挑战性,但转化精准医学的出现将有助于以机制为中心的转化医学和以患者为中心的精准医学的整合。
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引用次数: 0
Anesthetic Implications of Nephrotic Syndrome in Neurosurgical Practice 神经外科实践中肾病综合征的麻醉意义
Q4 ANESTHESIOLOGY Pub Date : 2022-05-05 DOI: 10.1055/s-0042-1744400
Roshna C. Puthiyedath, Ashutosh Kumar, R. Praveen, M. Sethuraman
Abstract Nephrotic syndrome (NS) is a common medical disorder especially in pediatric population with hypoproteinemia as an important feature. NS has multisystem involvement and multiple organ effects due to the disease or the treatment itself, which has important implications in the perioperative period. Hypoproteinemia in NS can result in reduction in availability of protein binding sites for certain intravenous anesthetics, leading to their increased free fraction that can concentrate at the receptor sites, thereby prolonging their action. NS can have phases of relapse and remission with increased propensity for complications, such as thromboembolism during relapse phase. Such patients presenting for neurosurgery pose unique challenge to the anesthesiologist. We hereby report a case of NS and its implication in neurosurgical practice and management.
摘要肾病综合征(NS)是一种常见的医学疾病,尤其是在以低蛋白血症为重要特征的儿科人群中。由于疾病或治疗本身,NS具有多系统受累和多器官影响,这在围手术期具有重要意义。NS中的低蛋白血症可导致某些静脉麻醉药的蛋白质结合位点的可用性降低,导致其可集中在受体位点的游离部分增加,从而延长其作用。NS可能有复发和缓解的阶段,并发症的倾向增加,如复发期的血栓栓塞。这样的神经外科患者给麻醉师带来了独特的挑战。我们在此报告一例NS及其在神经外科实践和管理中的意义。
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引用次数: 1
Acute Pulmonary Edema with Paradoxical Desaturation after Salbutamol due to Venous Air Embolism during an Awake Craniotomy: A Diagnostic Challenge 清醒开颅术中静脉空气栓塞导致沙丁胺醇后急性肺水肿伴反常去饱和:诊断挑战
Q4 ANESTHESIOLOGY Pub Date : 2022-05-05 DOI: 10.1055/s-0042-1744403
Amy H. S. Kong, P. Woo, Wilson M. Y. Choo, D. K. Wong
A 75-year-old non-smoker with good past health underwent an awake craniotomy for motor mapping and glioblastoma resection. During the procedure, she was sedated by intravenous propofol and remifentanil using target-controlled infusion (TCI) with bispectral index monitoring (target: 70–80). The effect-site drug concentrations were titrated between 1 and 2 µg/mL and 0 to 1 ng/mL, respectively. The patient was placed in a semi-sitting position (30-degree head up). The patient’s systolic blood pressure dropped slightly after the start of sedation; her other vital signs remained normal ( ►Fig. 1 ). Within 10minutes after bone flap removal, the patient coughed briefly followed by a transient drop in SpO 2 to 78% and end tidal CO 2 (EtCO 2 ) to 1.7 kPa. Because her SpO 2 and EtCO 2 promptly improved after applying jaw thrust and nasopharyngeal airway, this episode was attributed to deep sedation. Sedation was stopped and the patient was asymptomatic after regaining consciousness. Sixty minutes later, during brain mapping, a gradual decline in SpO 2 to 92% was observed with no reduction in EtCO 2 . The patient remained asymptomatic with no clinical seizures and no epileptogenic activity noted during electrocorticography.
一位75岁的非吸烟者,既往健康状况良好,接受清醒开颅手术进行运动测绘和胶质母细胞瘤切除术。在手术过程中,患者采用靶控输注(TCI)静脉注射异丙酚和瑞芬太尼镇静,双谱指数监测(目标:70-80)。作用部位药物浓度分别在1 ~ 2µg/mL和0 ~ 1 ng/mL之间滴定。患者处于半坐位(头部向上30度)。镇静开始后患者收缩压略有下降;她的其他生命体征都正常。1)。骨瓣移除后10分钟内,患者出现短暂咳嗽,随后spo2瞬间降至78%,末潮co2 (EtCO 2)降至1.7 kPa。由于她的SpO 2和EtCO 2在应用颌突和鼻咽气道后迅速改善,此事件归因于深度镇静。停止镇静,患者恢复意识后无症状。60分钟后,在脑部测绘期间,观察到SpO 2逐渐下降到92%,而EtCO 2没有下降。患者无症状,无临床癫痫发作,在皮质电图中没有发现致痫性活动。
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引用次数: 1
Can the Processed EEG Be Utilized as a Cerebral Ischemia Monitor during the Temporary Clip Application in Anterior Circulation Aneurysm Surgery? 处理后的脑电图在前循环动脉瘤手术中的临时夹应用中可以用作脑缺血监测仪吗?
Q4 ANESTHESIOLOGY Pub Date : 2022-05-05 DOI: 10.1055/s-0042-1744396
R. Mariappan, S. Krothapalli, Bijesh Nair, Benjamin F. Alexander
Patients undergoing cerebral aneurysm clipping are at risk for cerebral ischemia. Ischemic tolerance varies among individuals. Hence, multimodal intraoperative neuromonitoring (IONM) is essential. IONM is not available in many centers. This case report highlights the utilization of processed electroencephalography (EEG) as a cerebral ischemia monitor during temporary clip application. Our patient underwent clipping of a ruptured anterior-communicating artery aneurysm. After the temporary clip applications on the right and left, A1 arterial segments led to a transient drop of somatosensory evoked potentials (SSEPs). At the same time, the frontal four-channel processed EEG showed a burst suppression (BS) pattern. Blood pressure augmentation and the removal of temporary clips helped restore the SSEP back to baseline and the disappearance of the BS pattern in processed EEG. During the steady state of anesthesia, the sudden appearance of the BS pattern in processed EEG can be attributed to clip-induced cerebral ischemia after ruling out other potential causes for BS.
接受脑动脉瘤夹闭术的患者有发生脑缺血的风险。缺血耐受性因个体而异。因此,多模式术中神经监测(IONM)是必不可少的。IONM在许多中心都不可用。本病例报告强调了在临时剪辑应用过程中使用处理脑电图(EEG)作为脑缺血监测仪。我们的病人接受了前交通动脉瘤破裂的夹闭术。在右侧和左侧的临时夹敷后,A1动脉段导致体感诱发电位(SSEP)的短暂下降。同时,经额叶四通道处理的脑电呈现突发抑制(BS)模式。血压升高和移除临时夹有助于将SSEP恢复到基线,并使处理后的EEG中的BS模式消失。在麻醉稳定状态下,在排除了BS的其他潜在原因后,处理后的脑电图中突然出现BS模式可归因于剪辑诱导的脑缺血。
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引用次数: 0
A Rare Case of Drug Interaction Presenting as Perioperative Hyperthermia in a Patient Presenting for Neurosurgery 一例罕见的药物相互作用表现为神经外科患者围手术期热疗
Q4 ANESTHESIOLOGY Pub Date : 2022-05-05 DOI: 10.1055/s-0042-1744398
Sapna Suresh, A. Hrishi, M. Sethuraman
Abstract Perioperative hyperthermia has many differential diagnoses. This case report describes the rare causation of perioperative hyperthermia in a patient presenting for epilepsy surgery. The patient had two episodes of hyperthermia, initially post-anesthetic induction and later in the immediate post-operative period. The quest for the etiology sheds light on a rare drug interaction between topiramate, an antiepileptic drug, and glycopyrrolate causing intraoperative hyperthermia. However, the literature has not reported drug interaction between topiramate and glycopyrrolate resulting in perioperative hyperthermia. The combination of a glycopyrrolate-induced rise in temperature and oligohidrosis could have resulted in hyperthermia in our patient. Thus, it is prudent to avoid glycopyrrolate in the perioperative period when patients are on topiramate.
摘要围手术期热疗有许多鉴别诊断。本病例报告描述了癫痫手术患者围手术期体温过高的罕见原因。患者有两次高热发作,最初是在麻醉诱导后,后来是在术后不久。病因的探索揭示了托吡酯(一种抗癫痫药物)和格隆吡咯烷酸酯之间罕见的药物相互作用,导致术中体温过高。然而,文献尚未报道托吡酯和格隆吡咯烷酸酯之间的药物相互作用导致围手术期热疗。格隆吡咯酸盐引起的体温升高和少汗症的结合可能导致我们的患者体温过高。因此,当患者服用托吡酯时,谨慎的做法是在围手术期避免使用格隆吡咯酸盐。
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引用次数: 1
Phenytoin-Induced Toxic Epidermal Necrolysis with Immediate Remission Post Intravenous Immunoglobulin Therapy 苯妥英钠诱导的毒性表皮坏死松解与静脉注射免疫球蛋白治疗后立即缓解
Q4 ANESTHESIOLOGY Pub Date : 2022-03-01 DOI: 10.1055/s-0042-1744393
Balaji Vaithialingam, Radhakrishnan Muthuchellappan
Seizure is a common manifestation of supratentorial intracranial parenchymal tumors.1 Phenytoin is used for seizure control in the perioperative period. Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous condition involving more than 30% of the body surface area and is not commonly encountered in clinical practice. Antiepileptics are notorious for causing TEN.2 A 63-year-old female was admitted to the neurosurgical emergency department with recent onset, intermittent, focal seizures involving the right upper limb. Clinical examination was unremarkable. She was started on intravenous phenytoin —an initial 1,000mg loading dose followed by 100mg thrice daily.Magnetic resonance imagingof thebrain revealedacystic lesion involving the left frontoparietal areawithout significant mass effect. She underwent elective craniotomy and tumor decompression under general anesthesia with an uneventful intraoperative course. On postoperative day 1, the patient developed one episode of generalized tonic–clonic seizure followed by deterioration of sensorium. She was shifted to the neurosurgical intensive care unit (NSICU), intubated, and mechanically ventilated. On arrival to the NSICU, diffuse erythemawas noted involving the face, trunk, and extremities with oralmucosal involvement. The possibility of adverse drug reaction was considered, and all the possible medications (antibiotics, analgesics, and phenytoin) were withheld, and the patient was treated with intravenous hydrocortisone. A reviewofhistory fromclose relatives revealeda similar event in the past (5 years before) following consumption of oral phenytoin tablets. Onpostoperative day 2 inNSICU, the skin rashes becameveryprominentwith the appearanceofblisters all over the body followed by skin peeling (►Fig. 1A,B) and oozing of fluids. A probable diagnosis of phenytoin induced TEN was considered. Fluid balance was optimized, and vasopressors were initiated to maintained hemodynamic stability. Lowdose intravenous ketamine infusion at 0.25mg/kg/h was started toprovideanalgesia. Skincarewasprovidedbyapplying liquid paraffin-soaked gauges over the exposed areas and wrapping the patient with banana leaf. Intravenous immunoglobulin (IVIG) was started (0.5 gm/kg/day) as a definitive treatment for TEN. Patient had dramatic improvement in the skin condition with the disappearance of blisters on day 2 of IVIG therapy. Following completion of IVIG course onday5, the general condition improved considerably, requiring minimal hemodynamic support. The trachea was extubated, and the patientwasdischargedwith full sensoriumafter10daysof stay in the NSICU. Stevens–Johnson syndrome (SJS) and TEN are spectra of the same mucocutaneous condition classified based on the extent of skin involvement (SJS <10% and TEN >30% body surface area). TEN is commonly differentiated from other drug rashes by the presence of oozing blisters and extensive skin peeling. Supportive treatment along with skincare are the two corner
癫痫发作是幕上颅内实质肿瘤的常见表现。1苯妥英可用于围手术期的癫痫控制。中毒性表皮坏死松解症(TEN)是一种危及生命的粘膜皮肤病,涉及超过30%的体表面积,在临床实践中并不常见。抗癫痫药因导致TEN而臭名昭著。2一名63岁的女性因近期发作、间歇性、局灶性癫痫发作(涉及右上肢)而住进神经外科急诊室。临床检查不明显。她开始静脉注射苯妥英,最初的负荷剂量为1000mg,然后每天三次,每次100mg。大脑的磁共振成像显示了左侧额顶区的囊肿病变,没有明显的肿块效应。她在全身麻醉下接受了选择性开颅手术和肿瘤减压,术中过程平静。术后第1天,患者出现一次全身强直-阵挛发作,随后感觉功能恶化。她被转移到神经外科重症监护室(NSICU),插管并进行机械通气。到达NSICU后,发现面部、躯干和四肢弥漫性红斑,口腔粘膜受累。考虑到药物不良反应的可能性,并停止使用所有可能的药物(抗生素、止痛药和苯妥英),并对患者进行静脉注射氢化可的松治疗。近亲属的历史回顾显示,在过去(5年前)服用口服苯妥英片后也发生过类似事件。NSICU术后第2天,皮疹非常明显,全身出现水泡,随后出现皮肤剥落(►图1A、B)和流体渗出。考虑了苯妥英诱发TEN的可能诊断。优化了液体平衡,并启动了血管升压药以维持血液动力学稳定性。开始低剂量静脉滴注0.25mg/kg的氯胺酮以提供镇痛作用。皮肤护理是通过在暴露区域使用液体石蜡浸泡的测量仪并用香蕉叶包裹患者来提供的。开始静脉注射免疫球蛋白(IVIG)(0.5克/kg/天)作为TEN的最终治疗。IVIG治疗第2天,患者的皮肤状况显著改善,水泡消失。IVIG疗程5结束后,一般情况明显改善,需要最低限度的血液动力学支持。拔出气管,患者在NSICU停留10天后,在充满感觉的情况下出院。Stevens-Johnson综合征(SJS)和TEN是根据皮肤受累程度(SJS 30%体表面积)分类的同一粘膜皮肤疾病的光谱。TEN通常与其他药物皮疹的区别在于存在渗出的水泡和广泛的皮肤剥落。支持性治疗和护肤是治疗SJS和TEN的两大基石。除了别嘌醇、磺酰胺、β-内酰胺类抗生素和奈韦拉平外,抗惊厥药物是罪魁祸首。在印度,用香蕉叶包裹身体是一种传统的护肤方法,已被证明具有有益效果。3尽管对TEN没有明确的治疗方法,但过去曾尝试过类固醇和IVIG。在TEN中使用类固醇是有争议的,因为它会导致败血症并恶化死亡率。Lee等人没有记录任何
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引用次数: 1
Presentation to Publication in Neuroanesthesia 发表在《神经麻醉》杂志上的演讲
Q4 ANESTHESIOLOGY Pub Date : 2022-03-01 DOI: 10.1055/s-0042-1748313
Ankur Khandelwal, G. Rath
institutions were significantly associated with publications after conference presentations.1 It is an interesting observation in view of what happens to the neuroanesthesia presentations in India, but the study has apparent limitations being retrospective in nature. It is unknown whether most of these unpublished presentations were actually submitted to a journal and underwent peer-reviewing and got rejected. It is also not known whether there was any difference in conversion rate between platform versus poster presentations. Platform/ oral presentations are most often competitive presentations and undergo a stringent peer-review process. Hence, there is a possibility that the conversion rate of presentations into publications could be better.2 Several factors may be responsible for the nonconversion of presentations into publications. First, the organizing scientific committee in most of the conferences hardly rejects any abstract that is submitted for presentation. Ideally, there should be a balance between quality and quantity while accepting the scientific abstracts. The existing process of encouraging scientific presentations for each interested unintentionally invites low-quality research works for presentation. These presentations eventually fail to undergo a stringent peer-review process during the publication cycle. Second, it is common to present the interim results of the research works during the meeting. While the study may be innovative and well-designed at the time of presentation, by the time it is completed and drafted, articles of similar objectives might get published by different researchers, thereby losing their relevance and low consideration for publication. Third, many journals currently do not consider case reports for publication, despite being widely encouraged for presentations during conferences. Moreover, the scope of publication from private hospitals is much less as compared with academic/public-funded institutions. This is because of the lack of research mentorship Presentations in the form of the platform (oral) and poster discussions are norms during the scientific meetings, including continued medical education activities. These presentations may be in a competitive category or noncompetitive (free paper) formats. The main objective for encouraging these scientific presentations is to bring to light new research and simultaneously fill the gap in existing knowledge. The usual categories of presentations include research papers and case reports. In addition, some of the conferences also promote presentations/exhibitions of innovations, infographics, etc. The research work gets the credit in this process, and the researcher/presenter gets due recognition on a bigger platform with a large audience. Moreover, such presentations also help enhance the verbal communication skills of the presenters, some of whom transform into brilliant speakers of national and international repute. In concordance with the scientific
机构与会议报告后的出版物显著相关这是一个有趣的观察,鉴于发生在印度的神经麻醉的介绍,但研究有明显的局限性是回顾性的性质。目前尚不清楚这些未发表的报告是否真的提交给了期刊,并经过了同行评审而被拒绝。我们也不知道平台与海报展示之间的转化率是否存在差异。平台/口头报告通常是竞争性的报告,并经过严格的同行评审过程。因此,有可能提高发言转化为出版物的比率有几个因素可能导致简报不能转化为出版物。首先,在大多数会议中,组织科学委员会几乎不会拒绝提交的任何摘要。理想情况下,在接受科学摘要的同时,应该在质量和数量之间取得平衡。现有的鼓励每个感兴趣的人进行科学报告的过程无意中邀请了低质量的研究工作进行报告。这些报告最终未能在出版周期中经过严格的同行评审过程。第二,在会议期间展示研究工作的中期成果是很常见的。虽然该研究在提交时可能具有创新性和良好的设计,但当它完成并起草时,类似目标的文章可能会由不同的研究人员发表,从而失去相关性和低考虑发表。第三,许多期刊目前不考虑发表病例报告,尽管它们被广泛鼓励在会议上发表报告。此外,与学术/公共资助机构相比,私立医院的出版范围要小得多。这是因为缺乏研究指导,在科学会议期间,包括继续的医学教育活动,以平台(口头)和海报讨论的形式进行报告是惯例。这些报告可以是竞争类别或非竞争(免费论文)格式。鼓励这些科学报告的主要目的是揭示新的研究,同时填补现有知识的空白。通常的报告类型包括研究论文和案例报告。此外,部分会议亦会推广创新、资讯图表等的介绍/展览。在这个过程中,研究工作得到了肯定,研究者/演讲者在更大的平台上得到了应有的认可。此外,这样的演讲也有助于提高演讲者的语言沟通能力,其中一些人变成了在国内和国际上享有盛誉的杰出演说家。与科学报告一致,期刊上的出版物给予研究工作最高程度的可信度,读者范围更广,甚至对研究人员的认可也更大。然而,一个值得关注的问题是,这些报告能否成功地翻译成索引期刊上的科学出版物。Krishnakumar等人1对神经麻醉会议后发表的全文出版物进行了审核和回顾性分析。他们发现,在印度神经麻醉学与重症监护学会(ISNACC)的5年(2014-2018年)年会上,只有17.5%(40/229)的报告被翻译成国家(45%)和国际(55%)期刊的出版物。从报告到发表的转化率明显低于其他麻醉学会的大多数会议。作者还观察到,发表率从2014年的21%大幅下降到2018年的8%。前瞻性队列研究、随机试验和学术/公众摘要
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引用次数: 0
Brain Biomarkers in Patients with COVID-19 and Neurological Manifestations: A Narrative Review COVID-19患者脑生物标志物与神经系统表现:叙述性综述
Q4 ANESTHESIOLOGY Pub Date : 2022-01-01 DOI: 10.1055/s-0042-1744395
Mayank Tyagi, I. Kapoor, C. Mahajan, N. Gupta, H. Prabhakar
Acute hyperinflammatory response (cytokine storm) and immunosuppression are responsible for critical illness in patients infected with coronavirus disease 2019 (COVID-19). It is a serious public health crisis that has affected millions of people worldwide. The main clinical manifestations are mostly by respiratory tract involvement and have been extensively researched. Increasing numbers of evidence from emerging studies point out the possibility of neurological involvement by COVID-19 highlighting the need for developing technology to diagnose, manage, and treat brain injury in such patients. Here, we aimed to discuss the rationale for the use of an emerging spectrum of blood biomarkers to guide future diagnostic strategies to mitigate brain injury-associated morbidity and mortality risks in COVID-19 patients, their use in clinical practice, and prediction of neurological outcomes.
急性高炎症反应(细胞因子风暴)和免疫抑制是2019冠状病毒病(COVID-19)感染患者重症的原因。这是一场严重的公共卫生危机,影响了全世界数百万人。主要临床表现以累及呼吸道为主,已被广泛研究。来自新出现的研究的越来越多的证据表明,COVID-19可能会影响神经系统,这凸显了开发诊断、管理和治疗此类患者脑损伤的技术的必要性。在这里,我们旨在讨论使用新兴血液生物标志物谱的基本原理,以指导未来的诊断策略,以减轻COVID-19患者脑损伤相关的发病率和死亡率风险,它们在临床实践中的应用,以及预测神经系统预后。
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引用次数: 2
期刊
Journal of Neuroanaesthesiology and Critical Care
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