每搏量变异度指导重型颅脑损伤手术患者容量治疗的效果  

Efficacy of volume therapy guided by stroke volume variability in patients undergoing surgery for severe traumatic brain injury

作　　者：孟利江 熊福丽 张山[1] 张志强[1] 边庆虎[1] 孟雅静[1] 李艳丽[1] Meng Lijiang;Xiong Fuli;Zhang Shan;Zhang Zhiqiang;Bian Qing- hu;Meng Yajing;Li Yanli(Department of Anesthesiology,Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院麻醉科,050000

出　　处：《中华麻醉学杂志》2018年第9期1119-1123,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价每搏量变异度(SVV)指导重型颅脑损伤手术患者容量治疗的效果。方法重型颅脑损伤患者30例,性别不限,年龄18~64岁,ASA分级Ⅲ级,受伤后24h内入院,术前格拉斯哥昏迷评分法(GCS)评分≤8分,采用随机数字表法分为2组(n=15):对照组(C组)采用常规补液法,维持MAP 65~110mmHg、CVP 5~12cmH2O和尿量>1m1·kg^-1·h^-1;SVV组根据SYV指导补液,维持SVV≤13%和MAP 65~110mmHg。分别于切皮即刻(T0)、开硬脑膜即刻(T1)、开硬脑膜后1h(T2)、关硬脑膜即刻(T3)和术毕(T4)时,采集颈内静脉球部血样和桡动脉血样行血气分析,记录颈内静脉球部血氧分压(PjvO2)、血氧饱和度(SjvO2)、乳酸和PaO2、SaO2、Hb,计算动静脉血氧含量差(Da-jvO2)和脑氧摄取率(CERO2)。于T0-2、T4和术后24h(T5)时,采集颈内静脉球部血样,采用ELISA法测定血清S100β蛋白浓度。记录术中液体出入量和血管活性药用量。分别于入室即刻、术后1、3、7和14d时记录GCS评分。记录术后住院时间及并发症(肺部感染和脑水肿)的发生情况。并于出院前采用格拉斯哥预后评分法评估患者术后早期生存质量。结果与C组比较,SVV组尿量增多,血管活性药物用量减少,T2,3时SjvO2升高,T2-4时CERO降低,T2时血清S100β蛋白浓度降低,术后3d时GCS评分升高(P<0.05),各时点乳酸浓度、术后格拉斯哥预后评分法评分和住院时间差异无统计学意义(P>0.05)。结论SVV指导下的容量治疗用于重型颅脑损伤手术患者可改善脑氧代谢,保证组织灌注,减轻颅脑损伤。Objective To evaluate the efficacy of volume therapy guided by stroke volume variability (SVV)in the patients undergoing surgery for severe traumatic brain injury.Methods Thirty patients of both sexes with severe traumatic brain injury,aged 18-64yr,of American Society of Anesthesiologists physical status Ⅲ,who were admitted to the hospital within 24h after injury,with Glasgow Coma Scale (GCS)score ≤8,were divided into control group (C group,n =15)and SVV group (n =15)using a random number table method.In group C,conventional fluid administration was performed to maintain mean arterial pressure at 65-110mmHg,central venous pressure at 5-12cmH2O and urine volume >1 ml·kg^-1·h^-1.Fluid was given according to SVV,maintaining SVV≤13% and mean arterial pressure at 65-110mmHg in group SVV. Immediately after skin incision (T0 ),immediately after opening cerebral dura mater (T1),at 1h after opening cerebral dura mater (T2),immediately after suturing cerebral dura mater (T3)and at the end of operation (T4),blood samples were collected from the radial artery and internal jugular venous bulb for blood gas analysis,the jugular venous oxygen partial pressure,jugular venous bulb oxygen saturation,blood lactate,arterial oxygen partial pressure,arterial oxygen saturation and Hb were recorded,and the cerebral artery and arteriovenous blood O2 content difference and cerebral O2 extraction rate were calculated.Blood samples were collected from the internal jugular venous bulb at T0-2,T4 and 24h after operation (T5)for determination of S100β protein concentrations by enzyme-linked immunosorbent assay.The intraoperative volume of fluid intake and output and consumption of vasoaetive drugs were recorded.GCS scores were recorded immediately after admission to the operating room,and at 1,3,7 and 14 days after operation.The development of postoperative length of hospitalization and complications (pulmonary infection and brain edema)was recorded.Glasgow Outcome Scale Score was used to assess the early postoperative quality of life

关 键 词：每搏量输出量 补液疗法 颅脑损伤 

分 类 号：R651.15[医药卫生—外科学]