Neurocritical care is an important branch of critical care medicine. The mechanism of critical neurological damage is complex and diverse, and the pathophysiology changes rapidly. Different pathophysiological changes determine different degrees of brain injury. In a special plateau environment, the incidence of critical neurological disease is higher, the age of onset is younger, the disease progress is faster, and the degree of damage is more severe. In order to standardize the diagnosis and treatment, enhance monitoring and management, provide timely and precise treatment, prevent irreversible brain injury, and improve the prognosis of patients with critical neurological illness at high altitudes, the Research Group of Calm Treatment of China, Research Group of Critical Care Ultrasound of China, and the Quality Control Center of Critical Care Medicine in Tibet formulated the Expert Consensus on Monitoring and Management of Patients with Critical Neurological Illness at High Altitudes on the basis of full discussion and communication of relevant critical medical experts and neurosurgery experts according to domestic and foreign literature and years of experience in clinical application and promotion. The main contents of the consensus are as follows.(1) According to the pathophysiological mechanism of neurological involvement in critical illness, scenarios of neurocritical care at high altitudes can be divided into cerebral hemorrhage at high altitudes, severe traumatic brain injuries, ischemic stroke, cerebral edema at high altitudes, and septic encephalopathy (8.4 points).(2) It is recommended to use cerebral blood flow, brain function monitoring and cerebral oxygen saturation as a 'triad' monitoring core in management of neurocritical care at high altitude, to as well as cerebrospinal fluid dynamics monitoring and brain structure surveillance (9.0 points).(3) It is recommended to grade patients quickly, and the '5-avoids' approach based on 'brain protection' theory were adhered to avoid fever, seizures, anxiety, agitation or pain, shivering, stimulation and nociception, according to different levels. Especially in the 'super critical' stage, with the protection of '446'targets, choose the window for analgesia and sedation (8.4 points).(4) It is recommended to monitor systemic and cerebral hemodynamic continuously and dynamically in order to improve systemic perfusion and optimize cerebral perfusion simultaneously (8.4 points).(5) It is recommended to choose the method of direct measurement of intracranial pressure by intraventricular catheter or optic nerve sheath diameter under ultrasound to estimate intracranial pressure, and choose the appropriate target mean arterial pressure to ensure optimal brain perfusion (8.8 points).(6) It is recommended to use transcranial Doppler ultrasound to evaluate the blood flow velocity and blood flow waveform of the bilateral cerebral arteries. It is recommended to target the blood flow velocity of M1 at 40 cm/s in the 'super critical' period (8.2 points).(7) In the 'super critical' period, we recommend to routinely monitor BIS and maintain the BIS value around 40 as the goal to guide the depth of sedation; those with conditions can be monitored by quantitative electroencephalography to assist determining whether there are non-convulsive seizures, and perform diagnostic evaluation of the prognosis (8.6 points).(8) It is recommended to monitor brain oxygen levels routinely, starting early in the ICU admission of patients with critical neurological conditions at high altitudes, which can assist in the assessment of brain damage (8.6 points).(9) It is recommended to evaluate the cerebral blood flow self-regulation ability routinely to achieve the optimal cerebral perfusion pressure in time and timely adjust the intensity and scheme of treatment (8.2 points).(10) It is recommended to emphasize the importance of target arterial partial pressure of carbon dioxide in the artery in critical illness and neurocritical care at high altitudes (8.0 points).(11) It is recommended to devote attention to the importance of targeted temperature management in in critical illness and neurocritical care at high altitudes (8.6 points).(12) It is recommended that multidisciplinary consultation and multi-professional cooperation could improve the management in critical neurological illness at high altitudes (8.8 points).(13) It is recommended that the constitution of improvement in brain structure imaging, pressure normalization of cerebrospinal fluid and restoration of cerebral blood autoregulation could be as the de-escalation triad (8.0 points).(14) It is recommended to be cautious of paroxysmal sympathetic hyperreactivity patients in neurocritical and critical illness at high altitude (8.0 points).(15) It is recommended to be cautious about the management of agitation (delirium) and cognitive function of patients in TBI at high altitudes(8.0 points).(16) It is recommended to assess the itinerary of the rehabilitation in a timely manner for critically sick patients at high altitudes (8.2 points).(17) It is recommended to be cautious of post-traumatic hydrocephalus and related neuroendocrine abnormalities in patients with critical neurological illness at high altitudes (7.6 points).

目的 重症超声快速诊断方案在急性呼吸衰竭病因诊断中的作用.方法 选择2017年5月至2018年3月间我院收治的62例急性呼吸衰竭患者,按照随机数字表法将患者划分为观察组与常规组各31例,为观察组患者提供重症超声快速诊断方法,常规组接受一般查体及实验室检查,评价两组患者病因诊断准确率及诊断用时.结果 观察组患者病因诊断准确率高于常规组,P<0.05.观察组患者初步诊断用时、确定诊断用时均短于常规组,P<0.05.结论 针对急性呼吸衰竭患者应用重症超声快速诊断方案进行干预,可帮助快速确定病因,缩短诊断用时.

目的探讨高原地区急性呼吸窘迫综合征的治疗体会和临床疗效。方法对30例急性呼吸窘迫综合征的诊断和治疗进行临床分析。结果完全恢复14例,死亡16例。结论急性呼吸窘迫综合征必须早诊断,合理治疗,最大程度阻断病情恶化,提高治愈率;高效呼吸机治疗是成功的关键。

目的总结床旁经皮穿刺气管置管术(PDT)在临床中应用的体会。方法回顾性分析我院ICU实施PDT救治8例危重患者的临床资料。结果 8例患者PDT操作均顺利完成,手术时间平均其中30分钟,1例出现并发出血。结论较传统气管切开术,对危重患者实施PDT,耗时短,操作简捷,手术成功率高,手术创伤小,并发症少。

目的探讨高血压脑出血引起高钠血症的病因、临床特点及其预后。方法回顾性分析28例并发高钠血症的高血压脑出血患者,观察血钠程度与预后的关系。结果高钠血症是高血压脑出血患者的严重并发症,也会进一步加重脑损伤。血钠水平愈高,预后愈差。结论血钠水平可作为高血压脑出血患者的一项重要监测指标,对判断预后及指导治疗有重要意义。严密监测血清电解质,尽早发现高钠血症,控制恶性增高,可降低死亡率。