颅脑损伤患者血流动力学指标与住院转归相关性研究  

The correlation between hemodynamic parameters and hospitalization outcome in patients with traumatic brain injury

作　　者：宋婉晴 岳红丽[1] 陆瑜[1] 吴蓓[1] 于芸[1] 闫合燕 崔伟华[1] Song Wanqing;Yue Hongli;Lu Yu;Wu Bei;Yu Yun;Yan Heyan;Cui Weihua(Department of Anesthesiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,100070

出　　处：《国际麻醉学与复苏杂志》2021年第2期155-160,共6页International Journal of Anesthesiology and Resuscitation

基　　金：国家自然科学基金(81870865);北京市属医院科研培育项目(PX2019019);北京市自然科学基金(7173255)。

摘　　要：目的研究颅脑损伤(traumatic brain injury,TBI)患者EV1000血流动力学指标与住院转归的相关性,了解TBI患者术中血流动力学参数变化特点及EV1000血流动力学监测的临床意义。方法回顾性分析首都医科大学附属北京天坛医院2018年2月—2019年12月于全身麻醉下行颅内血肿清除术的TBI患者35例。根据去骨瓣前后(分别用0、1表示,将0、1置于相应血流动力学指标后以区分)的血流动力学指标将患者分为MAP低常组与MAP正常组、心率(heart rate,HR)高常组与HR正常组、心指数(cardiac index,CI)低常组与CI正常组、每搏量指数(stroke volume index,SVI)低常组与SVI正常组、全身血管阻力指数(systemic vascular resistance index,SVRI)低常组与SVRI正常组,分别分析去骨瓣前后不同血流动力学指标不同分组间患者入院及出院时格拉斯哥昏迷评分(Glasgow Coma Sore,GCS)的差异。单因素回归分析进一步明确各血流动力学指标与入院及出院GCS的相关性。结果去骨瓣前,各指标的不同分组间患者的年龄、性别、入院GCS差异无统计学意义(P>0.05)。MAP0低常组与MAP0正常组、CI0低常组与CI0正常组、SVRI0低常组与SVRI0正常组出院GCS差异无统计学意义(P>0.05)。而HR0高常组出院GCS低于HR0正常组(P<0.05),SVI0低常组出院GCS低于SVI0正常组(P<0.05)。去骨瓣后,各指标不同分组患者年龄、性别差异无统计学意义(P>0.05)。MAP1低常组与MAP1正常组、HR1高常组与HR1正常组、SVRI1低常组与SVRI1正常组患者入院GCS差异无统计学意义(P>0.05)。CI1低常组入院、出院GCS低于CI1正常组(P<0.05),SVI1低常组入院、出院GCS低于SVI1正常组(P<0.05),HR1高常组出院GCS低于HR1正常组(P<0.05)。MAP1低常组与MAP1正常组、SVRI1低常组与SVRI1正常组出院GCS差异无统计学意义(P>0.05)。在调整性别、年龄后,单因素线性回归分析结果显示,去骨瓣前各血流动力学指标是否异常与患者入院GCS无关联;去Objective To investigate the correlation between EV1000 hemodynamic parameters and hospitalization outcome in patients with traumatic brain injury(TBI)and to discuss the intraoperative characteristics of hemodynamic changes and evaluate the clinical significance of EV1000 hemodynamic monitoring in TBI patients.Methods A retrospective analysis was performed on 35 TBI patients undergoing craniotomy for hematoma evacuation under general anesthesia from February 2018 to December 2019 in Beijing Tiantan Hospital.According to the hemodynamic parameters before and after removal of the bone flap(they are represented by 0 and 1 respectively,and 0 and 1 are placed behind the corresponding hemodynamic parameters to distinguish them),the patients were divided into the following groups:a low mean arterial pressure(MAP)group and a normal MAP group,a high heart rate(HR)group and a normal HR group,a low cardiac index(CI)group and a normal CI group,a low stroke volume index(SVI)group and a normal SVI group,a low systemic vascular resistance index(SVRI)group and a normal SVRI group.The differences in Glasgow Coma Scale(GCS)scores on admission and discharge were analyzed among these groups.Univariate regression analysis was used to determine the correlation between these hemodynamic parameters and GCS on admission and discharge.Results Before removal of the bone flap,there were no statistical differences in age,gender or GCS on admission among the different groups(P>0.05).There were no statistical differences in GCS on discharge between the low MAP0 and normal MAP0 groups,the low CI0 and normal CI0 groups,the low SVRI0 and normal SVRI0 groups(P>0.05).The GCS on discharge in the high HR0 group was lower than that in the normal HR0 group(P<0.05),and the GCS on discharge in the low SVI0 group was lower than that in the normal SVI0 group(P<0.05).After removal of the bone flap,there were no statistical differences in age and gender among the different groups(P>0.05).There were no statistical differences in GCS on admission between the l

关 键 词：颅脑损伤 术中监测 血流动力学 格拉斯哥昏迷评分 

分 类 号：R651.15[医药卫生—外科学]