重型颅脑损伤患者急性期血流动力学的监测及其意义

Clinical significance of hemodynamics in acute phase of serious head injury

目的：观察重型颅脑损伤患者急性期血流动力学的变化，探讨其临床意义。方法：格拉斯哥昏迷评分（ＧＣＳ评分）８分以下、伤后６小时内入院患者，用Ｓｅｌｄｉｎｇｅｒ技术穿刺右颈内静脉，插入４腔７Ｆ漂浮导管，连续１周监测患者心率（ＨＲ）、平均动脉压（ＭＡＰ）、肺动脉压（ＰＡＰ）、肺毛细血管楔压（ＰＣＷＰ）、心排出量（ＣＯ）、心脏指数（ＣＩ）、中心静脉压（ＣＶＰ）和体循环血管阻力（ＳＶＲ）的变化。结果：伤后第１日，ＨＲ、ＭＡＰ、ＰＡＰ、ＰＣＷＰ、ＣＯ、ＣＩ和ＳＶＲ均比对照组升高，Ｐ均＜０．０５。ＣＶＰ伤后第３日〔（０．４０±０．１１）ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）〕、第５日〔（０．４６±０．０８）ｋＰａ〕明显降低，均低于伤后第１日〔（０．６１±０．０６）ｋＰａ〕和对照组〔（０．５８±０．１２）ｋＰａ〕，Ｐ＜０．０５和Ｐ＜０．０１。ＰＣＷＰ于伤后第３日〔（２．６７±０．８２）ｋＰａ〕、第５日〔（２．４６±０．５８）ｋＰａ〕虽低于伤后第１日〔（２．９８±０．２１）ｋＰａ〕，仍高于对照组〔（１．６６±０．５４）ｋＰａ〕，Ｐ均＜０．０５。结论：重型颅脑损伤患者伤后１周内血流动力学指标变化较大，严密观察血流动力学指标的变化对指?

Objective:To evaluate the clinical significance of hemodynamic changes in patients with serious head injury in acute phase.Methods:This study included patients who admitted to hospital within 6 hours after injury and Glasgow coma scale(GCS) score less than 8 points.Seldinger technique was used to penetrate right jugular vein and 7F SwanGanz catheter was inserted to determine hemodynamic parameters,including heart rate (HR),center venous pressure (CVP),mean arterial pressure (MAP),pulmonary arterial pressure (PAP),pulmonary capillary wedge pressure (PCWP),cardiac index(CI),cardiac output(CO) and systemic vascular resistance (SVR).Results:On 1st day after head injury,HR,MAP,PAP,PCWP,CO,CI and SVR were significantly higher than those in controls (all P <0 05).On 3rd and 5th days postinjury,CVP was decreased (0 40±0 11)kPa(1 kPa=7 5 mmHg) and (0 46±0 08)kPa compared with that on 1st day or controls respectively (0 61±0 06)kPa or (0 58±0 12)kPa, P <0 05或 P <0 01 .Although PCWP was much lower on 3rd and 5th days than that on 1st day (2 67±0 82)kPa,(2 46±0 58)kPa vs.(2 98±0 21)kPa,both P <0 05 ,it was markedly high compared with controls (1 66±0 54)kPa,both P <0 05 .Conclusions:Our data indicate that a remarkable change in hemodynamics could be observed in patients with serious head injury,and determination of hemodynamics may have clinical significance in treatment and prognosis.