儿童轻度创伤性脑损伤与脑震荡：现代病理生理学见解、诊断进展与主动管理方案。

文献信息

中文摘要

背景： 创伤性脑损伤和儿童脑震荡是全球主要的公共卫生问题。本叙述性综述旨在通过整合当前关于病理生理学、诊断进展、神经影像学、生物标志物和循证管理策略的证据，提供儿童脑震荡的最新概述。方法：脑震荡的病理生理学涉及复杂的神经代谢级联反应，其特征为离子失衡、线粒体功能障碍、脑血流改变、弥漫性轴索损伤和神经炎症。在儿童人群中，独特的神经发育易感性（头部与躯干比例较高、颈部肌肉较弱、髓鞘化仍在进行）会放大这些紊乱。结果：当代管理已从长期休息演变为早期主动恢复，包括短暂的初始休息（24-48小时），随后进行低于症状阈值的有氧运动、结构化的返校学习调整以及分阶段的恢复运动方案。新兴的诊断工具包括儿童SCAT6/儿童SCOAT6、前庭/眼动筛查以及血液生物标志物（GFAP、UCH-L1、NfL）。结论：未来研究应侧重于标准化儿童生物标志物阈值，并通过前瞻性多中心研究验证多模式诊断算法。

英文摘要

Traumatic brain injury and pediatric concussion represent major global public health concerns. This narrative review aims to provide an updated overview of pediatric concussion by integrating current evidence regarding pathophysiology, diagnostic advances, neuroimaging, biomarkers, and evidence-based management strategies. Concussion pathophysiology involves a complex neurometabolic cascade characterized by ionic imbalance, mitochondrial dysfunction, cerebral blood flow alterations, diffuse axonal injury, and neuroinflammation. In pediatric populations, unique neurodevelopmental vulnerabilities (higher head-to-torso ratio, weaker cervical musculature, ongoing myelination) magnify these disturbances. Contemporary management has evolved from prolonged rest to early active recovery, incorporating brief initial rest (24-48 h) followed by sub-symptom threshold aerobic exercise, structured return-to-learn accommodations, and stepped return-to-sport protocols. Emerging diagnostic tools include the Child SCAT6/Child SCOAT6, vestibular/ocular motor screening, and blood biomarkers (GFAP, UCH-L1, NfL). Future research should focus on standardizing pediatric biomarker thresholds and validating multimodal diagnostic algorithms through prospective multicenter studies.