早期目标导向性治疗对中型颅脑损伤合并创伤性休克患者的效果研究  

Effect of Early Goal-directed Therapy on Patients with Moderate Brain Injury and Traumatic Shock

作　　者：刘卓[1,2] 王倩梅[1] 雒番阳 龚晓亮[1] 王彦军[1] 尹文[1] 

机构地区：[1]第四军医大学西京医院急诊科,西安710032 [2]西电集团医院神经外科,西安710077 [3]陕西省第二人民医院心内科,西安710005

出　　处：《临床误诊误治》2016年第7期80-83,共4页Clinical Misdiagnosis & Mistherapy

基　　金：陕西省自然科学基础研究计划项目(2014JM4186);西京医院学科助推项目(XJZT14D10)

摘　　要：目的研究早期目标导向性治疗(early goal-directed therapy,EGDT)对中型颅脑损伤合并创伤性休克患者的效果。方法回顾性分析2009年11月—2015年11月我院收治的98例中型颅脑损伤合并创伤性休克患者临床资料,将2009年11月—2012年11月行传统液体复苏治疗患者48例纳入对照组,将2012年12月—2015年11月行EGDT患者50例纳入观察组。治疗后48 h比较两组总补液量、平均动脉压(mean arterial pressure,MAP)、血压波动幅度、格拉斯哥昏迷评分(Glasgow coma scale,GCS)及血乳酸水平,以及液体复苏6、48 h时凝血功能、心肾功能指标变化,并比较72 h开颅手术率及病死率。结果治疗48 h,观察组总补液量少于对照组,MAP、血压波动幅度、GCS评分均低于对照组,差异均有统计学意义(P<0.01)。观察组治疗48 h活化部分凝血活酶时间(APTT)、D-二聚体、肌酐、脑利钠肽(BNP)水平均优于对照组(P<0.05或P<0.01)。治疗72 h观察组开颅手术率及病死率均低于对照组(P<0.01)。结论 EGDT能改善中型颅脑损伤合并创伤性休克患者脏器灌注和氧供,提高血流动力学稳定性,促进凝血功能恢复,降低开颅手术率,改善预后。Objective To investigate the effect of early goal-directed therapy on patients with moderate brain injury and traumatic shock. Methods 98 patients with moderate brain injury and traumatic shock were treated in our hospital during November 2009 and November 2015, and the clinical data were analyzed respectively. 48 patients of control group had been given conventional fluid resuscitation treatment from November 2009 to November 2012, and 50 patients of observation group had been given early goal-directed therapy from December 2012 to November 2015. After 48 h of treatment, the levels of total resus fluid volume, mean arterial pressure, blood pressure fluctuation range, Glasgow coma scale and blood lactate were com- pared between the two groups. Meanwhile, the variations of coagulation function, renal function and cardiac function were compared between the two groups 6 b and 48 b after fluid resuscitation treatment. Results 48 h after treatment, the total resus fluid volume in observation group was less than that in control group. After fluid resuscitation treatment, the levels of blood pressure fluctuation range, Glasgow coma scale and blood lactate in observation group were lower than those in control group （P 〈 0.01 ）. And the levels of activated partial thromboplastin time （APTT） , D-Dimer, creatinine and brain natriuretic peptide （BNP） in observation group were better than those in control group after 48 h of treatment （P 〈0.05 or P 〈0.01 ）. 72 h after treatment, the rate of brain surgery and mortality rate of observation group were lower than that of control group （P 〈 0.01 ）. Conclusion For patients with moderate brain injury and traumatic shock, early goal directed therapy can improve organ perfusion and oxygen supply, the hemodynamics stability, blood coagulation, reduce surgical rate and improve prognosis of patients.

关 键 词：早期目标导向性治疗 复苏术 颅脑损伤 休克 创伤性 

分 类 号：R651.15[医药卫生—外科学] R605.971[医药卫生—临床医学]