高容量血液滤过对重型颅脑损伤患者脑保护作用的研究  

Protective Effect of High Volume Hemofiltration on the Treatment of Severe Brain Trauma

作　　者：孟建标[1] 赖志珍[1] 胡马洪[1] 许秀娟[1] 季春莲[1] 

机构地区：[1]浙江省立同德医院重症医学科,杭州310012

出　　处：《浙江中西医结合杂志》2018年第3期175-179,共5页Zhejiang Journal of Integrated Traditional Chinese and Western Medicine

基　　金：浙江省科技厅公益性技术应用研究基金项目(No.2013C33G5260034)

摘　　要：目的探讨高容量血液滤过(HVHF)对重型颅脑损伤患者脑保护作用及脑氧代谢的影响。方法将68例行去骨瓣减压术后持续行机械通气的重型颅脑损伤患者随机分为对照组和治疗组进行前瞻性非盲随机对照研究,每组34例。对照组在常规治疗基础上予以甘露醇0.5g/kg静脉滴注,每4h 1次;治疗组在对照组的基础上予以超滤量为60m L/(kg·h)的HVHF治疗,持续72h。治疗前及治疗后72h测定患者颈内静脉血氧饱和度(Sj VO_2)、颈内动脉-静脉血氧分压差(Da-jvO_2)、脑氧代谢率(CERO_2)、血清S-100β蛋白和神经元特异性烯醇化酶(NSE)水平变化。结果两组治疗前Sj VO_2、Da-jv O_2、CERO_2、血清S-100β蛋白以及NSE水平比较,差异无统计学意义(P均>0.05);与治疗前比较,两组患者治疗后72h Da-jv O_2、CERO_2、血清S-100β蛋白以及NSE水平均明显降低[Da-jv O_2:(39.76±16.31)m L/L比(58.33±30.84)m L/L、(29.62±12.41)m L/L比(51.29±23.88)m L/L;CERO_2:(26.89±12.25)%比(38.36±15.79)%、(19.41±10.82)%比(36.09±14.75)%;S-100β蛋白:(5.43±1.29)μg/L比(6.24±1.78)μg/L、(3.11±1.05)μg/L比(6.15±1.63)μg/L;NSE:(23.39±2.20)μg/L比(25.22±3.98)μg/L、(11.92±3.35)μg/L比(24.57±4.23)μg/L,P均<0.05],Sj VO_2水平均有升高[(72.36±15.48)%比(64.86±12.32)%、(84.15±16.20)%比(61.83±13.27)%,P均<0.05]。与对照组比较,治疗组治疗72h后Da-jv O_2、CERO_2、血清S-100β蛋白以及NSE水平均明显降低[Da-jv O_2:(29.62±12.41)m L/L比(39.76±16.31)m L/L;CERO_2:(19.41±10.82)%比(26.89±12.25)%;S-100β蛋白:(3.11±1.05)μg/L比(5.43±1.29)μg/L;NSE:(11.92±3.35)μg/L比(23.39±2.20)μg/L,P均<0.05],Sj VO_2水平明显升高[(84.15±16.20)%比(72.36±15.48)%,P<0.05]。结论与常规治疗比较,HVHF能有效降低重型颅脑损伤患者脑代谢水平,具有脑保护作用。Objective To investigate the effect of high volume hemofiltration(HVHF) on the cerebral metabolism in patients with severe trauma and its protective effect on the brain. Methods Sixty-eight patients of severe brain trauma and treated with decompressive craniectomy and mechanical ventilation were selected and randomly divided into 2 groups: control group(n=34) was given conventional treatment plus intravenous mannitol of 0.5 g/kg, once every 4 h, and treatment group(n=34) was given HVHF treatment [ultrafiltration volume at 60 m L/(kg·h) for 72 h] in addition to the conventional therapy. The jugular venous oxygen saturation(Sj VO2), difference of arterio-venous oxygen(Da-jv O2), cerebral oxygen extraction rate(CERO2), levels of serum S-100β and neuron-specific enolase(NSE) were compared before and after treatment in two groups. Results Before treatment, the levels of Sj VO2、Da-jv O2、CERO2、S-100β and NSE were not significantly different between treatment group and control group(P>0.05). After treatment, the level of Da-jv O2(39.76±16.31)m L/L, CERO2(26.89%±12.25%), S-100β(5.43±1.29)μg/L and NSE(23.39±2.20)μg/L in control group were decreased compared to those before treatment(Da-jv O2: 58.33±30.84 m L/L, CERO2: 38.36% ±15.79%, S-100β: 6.24 ±1.78μg/L, NSE: 25.22 ±3.98μg/L), while the level of Sj VO2 was increased(72.36%±15.18% vs 64.86% ±12.32%), all with P<0.05; the level of Da-jv O2(29.62±12.41 m L/L),CERO2(19.41% ±10.82%), S-100β(3.11 ±1.05μg/L) and NSE(11.92 ±3.35μg/L) after treatment in treatment group were also significantly reduced compared with those before the treatment(Da-jv O2: 51.29 ±23.88 m L/L, CERO2:36.09%±14.75%, S-100β: 6.15±1.63μg/L, NSE: 24.57±4.23μg/L), while the level of Sj VO2 was increased(84.15%±16.20% vs 61.83% ±12.31%), all with P <0.05. Conclusion HVHF can effectively reduce the level of cerebral metabolism and protect the function of brain in patients with severe traumatic injury.

关 键 词：重型脑损伤 高容量血液滤过 脑氧代谢 

分 类 号：R651.15[医药卫生—外科学]