京藏神经重症监测管理专家共识(2025)OA

Neurocritical care involves complex pathophysiological mechanisms,and its incidence is higher,injuries are more severe,and treatment is more challenging in high-altitude environments.This con-sensus,based on the latest domestic and international evidence-based medical data,establishes a standardized,goal-oriented framework for neurocritical care management applicable in high-altitude regions and nationwide.The consensus was developed following international standards for evidence quality assessment and underwent two rounds of Delphi expert consultation,resulting in 32 recommendation statements covering three parts:management systems,monitoring and assessment,and core strategies.Key updates include:advocating for the establishment of independent neurocritical care units and implementing precise tiered diagnosis and treat-ment based on the"Five Differences in Critical Care"concept;constructing a"trinity"multimodal brain moni-toring system centered on cerebral blood flow,cerebral oxygenation,and brain function,emphasizing routine bedside transcranial Doppler ultrasound,cerebral oximetry,and continuous electroencephalography monitoring;shifting management strategies from mild hypothermia therapy to targeted temperature management,and defining the"446"target management pathway for the supercritical stage;emphasizing the assessment of static and dynamic cerebrovascular autoregulation functions through multimodal methods to achieve individualized optimal mean arterial pressure management;elevating cerebrospinal fluid management goals to the level of"glymphatic system"function maintenance;implementing a multidisciplinary collaborative,whole-process management model focusing on patients'long-term neurological functional outcomes;de-escalation crite-ria include multidimensional indicators such as recovery of brain structure,restoration of cerebrovascular auto-regulation,improvement in cerebrospinal fluid dynamics,and reduction in biomarker levels;and integrating cutting-edge technologies like artificial intelligence into post-critical care management and rehabilitation plan-ning.This consensus systematically integrates the entire process of neurocritical care management,reflecting the modern connotation of goal-oriented,dynamic,and multimodal integration in neurocritical care medicine.It aims to adapt to new trends such as deepening understanding of pathophysiological mechanisms,the integra-tion of medicine and engineering,and the empowerment of artificial intelligence,thereby further advancing the discipline of critical care medicine.