儿科大脑血管的管理中的变化
Nicholas S Szuflita1, Silky Chotai2, Michael J Feldman2,3
11Monroe Carell Jr. Children's Hospital, Division of Pediatric Neurosurgery, Vanderbilt University Medical Center.
Journal of neurosurgery. Pediatrics
|November 15, 2024
概括
儿科大脑血管 (PCV) 是罕见的,治疗方法在专家之间有很大差异. 需要指导方针来规范小儿动脉瘤下arachnoid出血 (aSAH) 的预防,检测和治疗策略.
科学领域:
- 儿科神经学 儿科神经学
- 神经临界护理是指神经临界护理.
- 脑血管外科 脑血管外科
背景情况:
- 儿科大脑血管 (PCV) 是儿科动脉瘤下arachnoid出血 (aSAH) 的一个并发症.
- aSAH在儿童中不常见,对于PCV管理没有普遍的指导方针.
- 本研究评估了儿科aSAH和PCV管理中的当前实践模式.
研究的目的:
- 评估治疗小儿脑血管 (PCV) 的实践模式的变化,以治疗动脉瘤下arachnoid出血 (aSAH) 后的情况.
主要方法:
- 分发了一份REDCap调查,以评估PCV管理实践.
- 该调查的目标是AANS/CNS儿科和儿科神经临界护理研究小组的成员.
- 收集了来自专家的58个答案,主要是学术机构的神经外科医生和重症监护医生.
主要成果:
- 大多数医疗服务提供者每年治疗1-3例儿科aSAH,只有21%的人有协议化管理.
- 常见的PCV预防策略包括允许高血压 (90%),化学预防 (86%) 和流体管理 (83%).
- 检测PCV依赖于神经学检查 (60%) 和TCD (72%). 治疗包括容许性高血压 (50%) 和内血管方法 (81%的动脉内维拉帕米尔,67%的血管塑造).
结论:
- 儿科PCV是罕见的,由学术中心的专家管理,预防,检测和治疗的变化很大.
- 目前的策略可能是从成人范式中调整出来的,这凸显了缺乏标准化的儿科指导方针.
- 为儿科PCV管理制定基于证据的指导方针是优先事项.
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