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中华重症医学电子杂志 ›› 2026, Vol. 12 ›› Issue (02) : 118 -123. doi: 10.3877/cma.j.issn.2096-1537.2026.02.004

年度进展

重症神经:2025
刘雅玲1, 张丽娜1,2,()   
  1. 1 410008 长沙,老年疾病国家临床医学研究中心 中南大学湘雅医院重症医学科
    2 410008 长沙,湖南省重症医学临床研究中心
  • 收稿日期:2026-02-25 出版日期:2026-05-28
  • 通信作者: 张丽娜

Neurocritical care in 2025

Yaling Liu1, Lina Zhang1,2,()   

  1. 1 National Clinical Research Center for Geriatric Diseases, Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
    2 Hunan Provincial Clinical Research Center for Critical Care Medicine, Changsha 410008, China
  • Received:2026-02-25 Published:2026-05-28
  • Corresponding author: Lina Zhang
引用本文:

刘雅玲, 张丽娜. 重症神经:2025[J/OL]. 中华重症医学电子杂志, 2026, 12(02): 118-123.

Yaling Liu, Lina Zhang. Neurocritical care in 2025[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2026, 12(02): 118-123.

重症神经是重症医学与神经病学、神经外科学的交叉领域,聚焦急性脑损伤(ABI)患者的重症监测与诊疗。本文回顾2025年该领域代表性成果,缺血性脑卒中、出血性脑卒中及创伤性脑损伤(TBI)的治疗策略均有突破,明确了血管内治疗、输血策略等的临床价值;MK 4.0学说革新颅内压(ICP)管理理念,B-ICONIC共识规范无创颅内压(nICP)监测;同时,TBI多维评估框架、急性重症脑病共识及意识障碍(DoC)管理六步路线图相继出台,完善了诊疗路径。这些进展推动了重症神经领域的规范化、个体化发展,为改善ABI患者预后提供了重要支撑,也为后续研究指明了方向。

Neurocritical care is an interdisciplinary specialty integrating critical care medicine, neurology, and neurosurgery, focused on the comprehensive monitoring and management of patients with acute brain injury. This review summarizes major advances in neurocritical care reported in 2025. Recent progress in the management of ischemic stroke, hemorrhagic stroke, and traumatic brain injury (TBI) has further clarified the roles of endovascular therapy, transfusion strategies, and other targeted interventions in clinical practice. The introduction of MK 4.0 represents a paradigm shift in the understanding and management of intracranial pressure, while the B-ICONIC consensus has provided structured recommendations for the clinical application of noninvasive intracranial pressure monitoring. In addition, the development of a multidimensional assessment framework for TBI, the publication of a consensus statement on acute severe encephalopathy, and the proposal of a six-step roadmap for disorders of consciousness (DoC) have further refined current diagnostic and therapeutic pathways. Collectively, these advances reflect an ongoing transition toward greater standardization, precision, and individualized management in neurocritical care, with important implications for improving outcomes and guiding future research in acute brain injury.

表1 缺血性脑卒中临床研究汇总表
图1 Monro-Kellie学说示意图
图2 急性意识障碍管理六步路线
1
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2
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3
Langezaal LC, Van Der Hoeven EJ, Mont’alverne FJ, et al. Endovascular therapy for stroke due to basilar-artery occlusion [J]. New Engl J Med, 2021, 384(20): 1910-1920.
4
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5
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6
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7
Goyal M, Ospel JM, Ganesh A, et al. Endovascular treatment of stroke due to medium-vessel occlusion [J]. New Engl J Med, 2025, 392(14): 1385-1395.
8
Liu C, Guo CW, Li FL, et al. Intra-arterial Urokinase after endovascular reperfusion for acute ischemic stroke [J]. JAMA, 2025, 333(7): 589-598.
9
Huang J, Yang J, Liu C, et al; POST-TNK Investigators. Intra-arterial Tenecteplase following endovascular reperfusion for large vessel occlusion acute ischemic stroke: the POST-TNK randomized clinical trial [J]. JAMA, 2025, 333(7): 579-588.
10
Hu W, Tao CR, Wang L, et al. Intra-arterial tenecteplase after successful endovascular recanalisation in patients with acute posterior circulation arterial occlusion (ATTENTION-IA): multicentre randomised controlled trial [J]. BMJ, 2025, 388: e080489.
11
Miao Z, Luo G, Song L, et al; ANGEL-TNK Investigators. Intra-arterial Tenecteplase for acute stroke after successful endovascular therapy: the ANGEL-TNK randomized clinical trial [J]. JAMA, 2025, 334(7): 582-591.
12
Yang XG, He XJ, Xu YT, et al. Intra-arterial Alteplase after successful endovascular reperfusion in acute stroke [J]. JAMA, 2025, 334(19): 1728-1739.
13
Cottarelli A, Mamoon R, Ji R, et al. Low hemoglobin causes hematoma expansion and poor intracerebral hemorrhage outcomes [J]. Stroke, 2025, 56(5): 1234-1242.
14
Polymeris AA, Lang MF, Hakim A, et al. Effect of decompressive craniectomy according to location of deep intracerebral hemorrhage: a SWITCH trial analysis [J]. Stroke, 2026, 57(1): 12-19.
15
Yassi N, Zhao H, Churilov L, et al. Tranexamic acid versus placebo in individuals with intracerebral haemorrhage treated within 2 h of symptom onset (STOP-MSU): an international, double-blind, randomised, phase 2 trial [J]. Lancet Neurol, 2024, 23(6): 577-587.
16
Naidech AM, Jovanovic B, Wartenberg KE, et al. Higher hemoglobin is associated with improved outcome after subarachnoid hemorrhage [J]. Crit Care Med, 2007, 35(10): 2383-2389.
17
English SW, Delaney A, Fergusson DA, et al; SAHARA Trial Investigators on behalf of the Canadian Critical Care Trials Group; Canadian Critical Care Trials Group. Liberal or restrictive transfusion strategy in aneurysmal subarachnoid hemorrhage [J]. N Engl J Med, 2025, 392(11): 1079-1088.
18
Taleb C, Gouvea Bogossian E, Bittencour Rynkowski C, et al. Liberal versus restrictive transfusion strategies in subarachnoid hemorrhage: a secondary analysis of the TRAIN study [J]. Crit Care, 2025, 29(1): 67.
19
Larcipretti ALL, Udoma-Udofa OC, Gomes FC, et al. Transfusion practices in traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials [J]. Crit Care Med, 2025, 53(4): e963-e972.
20
Atkin-Jones T, Solorzano-Aldana MC, Rezk A, et al. Impact of oxygen and carbon dioxide levels on mortality in moderate to severe traumatic brain injury: a systematic review and meta-analysis [J]. Crit Care, 2025, 29(1): 357.
21
Taran S, Citerio G, Taccone FS, et al. Dynamic driving pressure and clinical outcomes in mechanically ventilated patients with acute brain injury: a secondary analysis of the VENTIBRAIN study [J]. Intensive Care Med, 2026, 52(1): 31-41.
22
Brasil S, Patriota GC, Godoy DA, et al. Monro-Kellie 4.0: moving from intracranial pressure to intracranial dynamics [J]. Crit Care, 2025, 29(1): 229.
23
Robba C, Picetti E, Vásquez-García S, et al. The Brussels consensus for non-invasive ICP monitoring when invasive systems are not available in the care of TBI patients (the B-ICONIC consensus, recommendations, and management algorithm) [J]. Intensive Care Med, 2025, 51(1): 4-20.
24
Manley GT, Dams-O'Connor K, Alosco ML, et al; NIH-NINDS TBI Classification and Nomenclature Initiative. A new characterisation of acute traumatic brain injury: the NIH-NINDS TBI Classification and Nomenclature Initiative [J]. Lancet Neurol, 2025, 24(6): 512-523.
25
Lisi I, Moro F, Mazzone E, et al. Exploiting blood-based biomarkers to align preclinical models with human traumatic brain injury [J]. Brain, 2025, 148(4): 1062-1080.
26
Sonneville R, Azabou E, Bailly P, et al. Management of severe acute encephalopathy in the ICU: an expert consensus statement from the French Society of Intensive Care Medicine [J]. Ann Intensive Care, 2025, 15(1): 37.
27
Bodien YG, Busl KM, Chang CWJ, et al. Disorders of consciousness diagnosis, interventions, and prognostication for the intensivist: report of the 2025 ISICEM roundtable [J]. Intensive Care Med, 2026, 52(1): 42-62.
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