等容血液稀释联合控制性降压在颅脑外伤手术治疗中的应用

发布时间：2018-04-29 07:56

本文选题：等容血液稀释 + 控制性降压　；参考：《山东医药》2017年34期

【摘要】：目的观察等容血液稀释联合控制性降压用于颅脑外伤患者手术治疗的效果。方法将160例颅脑外伤患者随机分为联合组、对照组各80例,联合组采用等容血液稀释联合控制性降压技术,对照组仅采取控制性降压技术,两组均行开颅血肿完全清除并去骨瓣减压术治疗。分别于全麻插管后等容血液稀释前(T_0)、等容血液稀释后控制降压前(T_1)、控制性降压30 min(T_2)、血肿清除后(T_3)、术毕(T_4)桡动脉采自体血,检测血流动力学、脑组织氧代谢指标;分别于术前、术后第6个月,采用Fugl-Meyer、Barthel量表评估患者的肢体运动功能、日常生活活动能力。术后第6个月,采用格拉斯哥预后评分(GOS)评价患者的预后。结果 T_0时,两组血流动力学、脑组织氧代谢指标差异均无统计学意义(P均0.05);T_1、T_2、T_3、T_4时,联合组平均动脉压、中心静脉压高于对照组而心率低于对照组(P均0.05),两组脑组织氧代谢指标差异无统计学意义(P均0.05)。术前、术后第6个月,两组Fugl-Meyer、Barthel评分比较差异无统计学意义(P均0.05);术后第6个月,两组Fugl-Meyer、Barthe评分较术前均增加(P均0.05)。术后第6个月,两组预后良好率比较差异无统计学意义(P0.05)。结论颅脑外伤患者手术中采用等容血液稀释联合控制性降压,有利于维持患者术中血流动力学的稳定,且不增加脑组织氧代谢量,有利于手术的开展。
[Abstract]:Objective To observe the effect of ISO hemodilution combined with controlled hypotension in the treatment of craniocerebral trauma. Methods 160 patients with craniocerebral trauma were randomly divided into combined group and 80 cases in the control group. The combined group was treated with ISO hemodilution combined with controlled hypotension, and the control group only took control hypotension, and two groups were all finished with craniotomy. The total clearance and bone flap decompression were performed before the ISO hemodilution (T_0) after the general anesthesia, the control of the blood dilution before the hypotension (T_1), the controlled hypotension 30 min (T_2), the hematoma clearance (T_3), the autologous blood from the radial artery after operation (T_4), the hemodynamics and the oxygen metabolism index of the brain tissue, respectively, before and sixth months after the operation, respectively, using Fu. Gl-Meyer, Barthel scale was used to evaluate the patients' motor function and daily living ability. Sixth months after operation, the prognosis of the patients was evaluated by the Glasgow prognostic score (GOS). Results there was no significant difference between the two groups of hemodynamics and brain tissue oxygen metabolism (P 0.05) at T_0, and the mean arterial pressure in the combined group when T_1, T_2, T_3, T_4. Central venous pressure was higher than control group and heart rate was lower than that of control group (P 0.05). There was no statistical difference between two groups of brain tissue oxygen metabolism (P 0.05). Before operation, sixth months after operation, two groups of Fugl-Meyer, Barthel scores were not statistically significant (P 0.05); sixth months after operation, Fugl-Meyer, Barthe score increased (P 0.05). Sixth months after operation, there was no significant difference in the good prognosis of the two groups (P0.05). Conclusion the use of ISO hemodilution combined with controlled hypotension in the operation of craniocerebral trauma is beneficial to maintain the stability of hemodynamics during the operation and do not increase the amount of oxygen metabolism in the brain tissue, which is beneficial to the operation.

【作者单位】：黔东南州人民医院;
【基金】：贵州省省长资金临床应用课题专项研究项目(黔省专合字2012-115号)
【分类号】：R651.15

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