连续性血液滤过对重型颅脑损伤患者脑血流动力学的影响  

Effects of continuous bloodhemofiltration on cerebral hemodynamics in patients with severe traumatic brain injury

作　　者：黎辉[1] 余阶洋[1] Li Hui Yu Jie- yang.(Intensive Care Unit, Guangxi Baise People＇s Hospital,Baise 533000, Chin)

机构地区：[1]百色市人民医院重症医学科,广西百色533000

出　　处：《中国急救医学》2017年第10期939-942,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨连续性血液滤过（continuous blood pufification，CBP）对重型颅脑损伤患者脑血流动力学及颅内压（intracranial pressure，ICP）的影响。方法收集2010～2016年百色市人民医院收治的重型颅脑损伤患者105例，随机分为CBP组和常规治疗组。CBP组患者在常规治疗基础上给予CBP。记录两组患者年龄、性别、颅脑损伤原因及类型、手术情况、发病到住院时间及入院时格拉斯哥昏迷量表（glasgow coma scale，GCS）评分、急性生理和慢性健康状况（acute physiology and chronic health evaluation，APACHEⅡ）评分。对所有患者分别在住院第1、3、5、10天进行GCS评分并测定相应时间的ICP。采用经颅多普勒超声（TCD）测定大脑中动脉（MCA）的收缩峰血流速度（Vs）、平均血流速度（Vm）和血管搏动指数（PI）。分别记录两组患者治疗第3、5及10天病死率。治疗6个月后随访，进行格拉斯哥结局评分（glasgow outcome score，GOS）。结果两组患者在住院第1天平均GCS评分、ICP、MCA的Vs、Vm和PI差异均无统计学意义（P〉0．05）。住院第3、5、10天CBP组患者平均GCS评分均较常规治疗组高（P〈0．05）。CBP组在住院第3、5及10天的ICP均较对照组低（P〈0．05）。住院第3、5、10天CBP组患者MCA的Vs、Vm均较常规治疗组高，PI较常规治疗组低（P〈0．05）。两组患者治疗3天时病死率比较差异无统计学意义（P〉0．05）。CBP组治疗5、10天病死率均较常规治疗组低，且差异有统计学意义（P〈0．05）。治疗6个月后，CBP组患者GOS评分高于常规治疗组（P〉0．05）。结论CBP可改善重型颅脑损伤患者临床症状、改善脑血流动力学，提高脑血液供应，降低患者近期病死率，改善患者预后，值得临床推广应用。Objective Toobservethe effects of continuous blood hemofihration（CBP） oncerebral hemodynamics and intracranial pressure（ICP） in patients with severe traumatic brain injury. Methods We collected 105 cases of severe traumatic brain injury in our hospital during 2010 -2016, and randomly divided them into the CBP group and the conventional treatment group. Thepatients in CBP group were given the CBP on the basis of conventional treatment. The age, gender, causes and types of craniocerebral injury, operation conditions, onset time and glasgoweoma scale （GCS）score, acute physiology and chronic health evaluation（ APACHE IT ）score of two groups were recorded. GCS score and ICP were performed in all patients on the 1St, 3rd, 5th and 10th day. The measurement of systolic peak blood flow velocity （ Vs ）, mean blood flow velocity （ Vm ） and blood vessel beat index （PI） of middle cerebral artery（MCA） were determined by TCD. We also recorded 3, 5 and 10 days of mortality rate. The glasgow outcome score （GOS） were followed up after 6 months of treatment. Results There was no significant difference in GCS score, ICP, Vs, Vm and PI of MCA between the two groups on the 1 st day （P〉0.05）. The average GCS scores of 3rd, 5th and 10th day of the CBP group were significantly higher than those in the conventional treatment group（P 〈0.05）. The ICP in 3rd, 5th and 10th day of the CBP group were significantly lower than those in the conventional treatment group（ P 〈 0.05 ）. Vs, Vm of MCA in 3rd, 5th and 10th day of the CBP group were significantly higher and PI were lowerthan those in the conventional treatment group （ P 〈 0.05 ）. There were no significant difference in mortality rate between the two groups in 3 days of treatment（ P 〉 0. 05 ）. The mortality rate in 5 and 10 days of the CBP group were significantly lower than that in the conventional treatment group（ P 〈 0. 05 ）. The GOS of the CBP group were higher than that of the conventional treatment group （ P �

关 键 词：连续性血液滤过 重型颅脑损伤 脑血流动力学 

分 类 号：R651.15[医药卫生—外科学]