协和医学杂志2026，Vol.17Issue(1)：59-72,14.DOI:10.12290/xhyxzz.2025-1151
京藏神经重症监测管理专家共识(2025)
Expert Consensus on Neurocritical Care Monitoring and Management in Beijing and Tibet(2025)
摘要
Abstract
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.关键词
北京/西藏/神经重症/监测与核心管理策略Key words
Beijing/Tibet/neurological critical care/monitoring and core management strategies分类
医药卫生引用本文复制引用
普布卓玛,旦增曲珍,付建垒,李茜玮,次央,刘一军,刘波,卓玛次仁,索朗玉珍,吉律,次仁桑珠,陈文劲,达瓦,郭娟,邱成,陈焕,王小亭,晁彦公,刘大为,柴文昭,胡成功,尹万红,张恒,朱世宏,神经重症监测管理共识⁃京藏高原共识组,神经重症监测管理共识⁃京藏高原共识编写组,张建,王晓猛,蔺国英,潘文君,桂喜盈,蔡鑫..京藏神经重症监测管理专家共识(2025)[J].协和医学杂志,2026,17(1):59-72,14.基金项目
国家重点研发计划(2022YFC2504503) （2022YFC2504503）
中央高水平医院临床科研专项(2022-PUMCH-B-026) （2022-PUMCH-B-026）
四大慢病重大专项(2024ZD0562100) （2024ZD0562100）
中国医学科学院临床与转化医学研究专项(2025-I2M-C&T-C-004) National Key Research and Development Program(2022YFC2504503) （2025-I2M-C&T-C-004）
Central High-level Hospital Clinical Re-search Project(2022-PUMCH-B-026) （2022-PUMCH-B-026）
Noncommunicable Chronic Diseases-National Science and Technology Major Project(2024ZD0562100) （2024ZD0562100）
Special Project of Clinical and Translational Medicine Research,Chinese Academy of Medical Sciences(2025-I2M-C&T-C-004) （2025-I2M-C&T-C-004）
