早期局部枸橼酸抗凝下CBP对重型颅脑损伤预后影响的研究  

Study on the Effect of CBP on the Treatment and Prognosis of Severe Craniocerebral Injury under Early Local Citrate Anticoagulation

作　　者：杨志勇[1] 梁慧屏[1] 邓舒雯[1] 何芷怡 林康越 陈锦玲 肖玉梅[1] YANG Zhiyong;LIANG Huiping;DENG Shuwen;HE Zhiyi;LIN Kangyue;CHEN Jinling;XIAO Yumei

机构地区：[1]广东省茂名市人民医院,广东茂名525000

出　　处：《中国医学创新》2020年第5期5-9,共5页Medical Innovation of China

基　　金：2017年度茂名市第一批(医疗卫生类)科技计划立项项目(2017245)。

摘　　要：目的:通过局部枸橼酸抗凝技术,探讨早期(伤后48 h内)实施持续血液净化(CBP)对重型颅脑损伤患者的治疗效果及预后的影响。方法:随机选取2017年1月-2019年6月广东省茂名市人民医院神经重症科收治的80例重型颅脑损伤患者为研究对象,按照随机数字表法将其分为试验组(40例)与对照组(40例)。对照组根据病情接受常规治疗,试验组接受常规治疗联合局部枸橼酸抗凝下CBP治疗。对比两组的治疗效果、脑水肿期常见并发症发生率、ICU 7 d转出率和预后,采用格拉斯哥昏迷评分(GCS)评估患者治疗前后临床生命体征缓解情况,采用格拉斯预后量表评分(GOS)评价患者伤后6个月的神经功能,统计预后生存及出院情况。结果:试验组患者治疗总有效率92.5%,高于对照组的75.0%(P<0.05)。试验组患者颅内压情况和脑水肿程度均优于对照组(P<0.05)。试验组脑水肿期的肺部感染率、连续3 d以上高热发生率、血钠浓度波动超15%发生率、急性肾损伤(AKI)发生率、BNP>1 000 pg/mL发生率、大面积水肿缺血或脑疝发生率、ICU 7 d转出率均低于对照组(P<0.05)。受伤后6个月,试验组格拉斯哥预后量表评分情况优于对照组,平均分高于对照组,差异均有统计学意义(P<0.05)。结论:通过局部枸橼酸抗凝,可对早期重型颅脑损伤患者实施持续血液净化治疗,一定程度上可改善治疗效果及预后,值得临床上推广使用。Objective:To investigate the effect of early (48 h after injury) continuous blood purification (CBP) on the treatment and prognosis of patients with severe craniocerebral injury by local anticoagulation of Citrate.Method:A total of 80 patients with severe craniocerebral injury admitted to the neurological ICU of Maoming People’s Hospital from January 2017 to June 2019 were selected,they were randomly divided into experimental group and control group,40 cases in each group.The control group received conventional treatment according to the condition,and the experimental group accepted conventional treatment combined with CBP therapy under local anticoagulation of Citrate.The treatment effect of two groups were compared,and the incidence rate of common complications,during cerebral edema stage,transfer rate of ICU and prognosis were also compared.The Glasgow coma score (GCS) and the prognostic scale (GOS) score were used to evaluate the remission of clinical vital signs and the neurological function after 6 months of patients with severe craniocerebral injury.The survival and discharge status were also evaluated.Result:The total effective rate of the experimental group was 92.5%,higher than 75.0% of the control group (P<0.05).The intracranial pressure and cerebral edema degree of the experimental group were better than those of control group (P<0.05).The incidence of pulmonary infection,continuous 3 d heat,serum sodium concentrations fluctuate by more than 15%,the incidence of AKI,BNP>1 000 pg/mL,ischemia or cerebral hernia,ICU 7 d turns out rate of the experimental group were lower than those in the control group (P<0.05).6 months after injury,the score of Glasgow prognostic scale in the experimental group was better than that in the control group,and the average score was higher than that in the control group,with statistically significant differences (P<0.05).Conclusion:CBP on severe craniocerebral injury under early local anticoagulation of Citrate can improve the therapeutic effect and prognosis to some exten

关 键 词：重型颅脑损伤 持续血液净化 局部枸橼酸抗凝 

分 类 号：R651.15[医药卫生—外科学]