复合性颅脑损伤合并急性呼吸窘迫综合征的早期目标性救治的探讨

Early Goal-directed Therapy of Compound Brain Injury with Acute Respiratory Distress Syndrome

目的探讨复合性颅脑损伤合并急性呼吸窘迫综合征的早期目标性救治的疗效。方法 70例随机分为常规治疗组(A组)和早期目标性救治组(B组),A组的治疗包括积极治疗创伤,机械通气,脱水止血,保持动脉收缩压>90mmHg,红细胞压积≥0.21,动脉血氧饱和度≥90%。B组在A组治疗的基础上实施肺保护性通气和镇痛镇静治疗,并要求2～24h内达到以下目标:中心静脉压5～8mmHg,平均动脉压75～110mmHg,尿量>1.0mL/(kg.h),红细胞压积≥0.27,中心静脉血氧饱和度(ScvO2)>70%,脑灌注压65～100mmHg,理想的动脉血气分析,动脉血乳酸(ABL)<2.0mmol/L。结果与A组比较,B组机械通气时间无差异,而吸气平台压、动脉二氧化碳分压、平均动脉压、中心静脉压、脑灌注压、动脉血氧含量、ABL、ScvO2等指标均有显著性差异,28d的病死率也有明显下降。结论早期目标性救治能够改善患者的预后,可能与改善组织灌注和氧代谢、保护重要脏器功能有关。

Objective To explore efficacy in the early goal-directed therapy of compound brain injury with acute respiratory distress syndrome. Methods All 70 patients were randomly divided into conventional treatment group （ A group ） and early goal-directed treatment group （ B group ）. A group treatment, including treatment of trauma, mechanical ventilation, Dehydrating agent, hemostasis, to maintain the systolic blood pressure 〉 90mmHg, hematocrit ≥ 0.21, arterial oxygen saturation ≥ 90%. B group therapy based on A group therapy and the implementation of lung protective ventilation and Analgesic sedation therapy, and requested to achieve the following goals within 2 - 24h： to maintain central venous pressure 5 - 8mmHg, mean arterial pressure of 75 - 110mmHg, urine output 〉 1.0mL/ （ kg·h ）, hematocrit ≥ 0.27, central venous oxygen saturation （ ScvO2 ） 〉 70%, cerebral perfusion pressure 65 - 100mmHg, Ideal arterial blood gas analysis, arterial blood lactate （ ABL ） 〈 2.0mmol/L. Results Compared with A, B group was no difference in duration of mechanical ventilation, and inspiratory plateau pressure, arterial carbon dioxide pressure, mean arterial pressure, central venous pressure, cerebral perfusion pressure, arterial oxygen content, ABL, ScvO2 other indicators were significantly differences, mortality in 28 days was a marked decline. Conclusion The goal-directed therapy can improve the prognosis of patients, improve tissue perfusion and oxygen metabolism and protect vital organs.