早期目标液体复苏对脑死亡血流动力学及氧代谢的影响

EFFECTS OF EARLY GOAL-DIRECTED FLUID RESUSCITATION ON HEMODYNAMICS AND OXYGEN METABOLISM AFTER BRAIN DEATH

目的:探讨采用早期目标导向液体复苏治疗对脑死亡后的血流动力学和氧代谢的影响。方法:对32例首次判定脑死亡的患者采用早期3h内进行目标导向液体复苏治疗,分别于首次判断为脑死亡后开始液体复苏前(T0),液体复苏后3h(T1),液体复苏后6h(T2),首次判断为脑死亡12h后(T3),通过桡动脉置管和Swan-Ganz导管获得心脏指数(CI)、平均肺动脉压(MPAP)、肺动脉楔压(PAWP)、中心静脉压(CVP)、全身血管阻力(SVR)、肺血管阻力(PVR)、氧供(DO2)、氧耗(VO2)、氧摄取率(ERO2)、动脉血乳酸(ABL)和混合静脉血氧饱和度(SvO2)。结果:与T0比较,T1～3时HR减慢(P<0.05),T1～3时MAP、CVP、PCWP、PAP、CI、SVR、PVP、DO2、VO2、SvO2升高(P<0.05或P<0.01),ERO2、ABL降低(P<0.05)。结论:脑死亡后早期出现血流动力学和氧代谢紊乱,早期目标导向液体复苏治疗可有效维持血流动力学的稳定,改善机体组织和器官的氧供需平衡。

Objective：To investigate the effects of early goal-directed treatment of fluid resuscitation on hemodynamics and oxygen metabolism after brain death.Methods：Thirty-two patients determined brain death in the first time were carried out goal-oriented treatment of fluid resuscitation in early 3 h after brain death.Radial artery was cannulated and Swan-Ganz catheter was placed via right internal jugular vein.The cardiac index（CI）,mean pulmonary artery pressure（MPAP）,pulmonary artery wedge pressure（PAWP）,central venous pressure（CVP）,systemic vascular resistance（SVR）,pulmonary vascular resistance（PVR）,oxygen supply（DO2）,oxygen consumption（VO2）,oxygen extraction rate（ERO2）,arterial blood lactate（ABL） and mixed venous oxygen saturation（SvO2） were measured before the fluid resuscitation（T0）,3 h after fluid resuscitation（T1）,6 h after fluid resuscitation（T2）,12 h after the first judge of brain death（T3）.Results：Compared with T0,MAP,CVP,PCWP,PAP,CI,SVR,PVP,DO2,VO2,SvO2 were significantly increased while ERO2,ABL were decreased after goal-oriented treatment of fluid resuscitation（P0.05 or P0.01）.Conclusion：There are hemodynamic and oxygen metabolic disorders in the early stage after brain death.The early goal-directed therapy of fluid resuscitation can effectively maintain hemodynamic stability,and improve the oxygen supply-demand balance of tissue and organs.