脑外伤患者血流动力学与生存率的相关性研究

The study of the association between hemodynamics and survival in patients with traumatic brain injury

目的:根据脑外伤患者生存和死亡的早期血流动力学、组织灌注和血管外肺水的不同情况,分析不同情况相关的发病机制,探求脑外伤患者的血流动力学情况与生存率的相关性。方法:回顾性分析2009-2010年沈阳军区总医院急诊科重症监护室(EICU)通过脉搏指示连续心排血量(PiCCO)监护仪的脑外伤患者45例,根据患者14d时的生存状况,分为存活组(n=29)和死亡组(n=16),记录两组初始GCS评分(GCS)、APACHEⅡ评分、TI指数(TI)和血流动力学参数,以及24h后的血流动力学参数。结果:14d后的总死亡率为36.7%。脑外伤患者早期都会出现心指数(CI)增高,心率(HR)增快,全心舒张末期容积(GEDI)以及血管外肺水指数(ELWI)正常,且随着时间的延长逐渐增加,死亡组增加的更加显著。存活组和GCS>8的心指数和心率显著高于死亡组和GCS≤8的(P<0.05)。结论:对于严重的脑外伤患者的早期,心指数、组织氧合、合理的液体管理可以提高患者生存率,死亡的脑外伤患者通常是的血流量不足从而导致了脑缺血的结果。

Objective： According to the differences of early hemodynamics, tissue perfusion and extravascular lung water between survivors and nonsurvivors after traumatic brain injury, the pathogenesis of different situations were analyzed. The association between the hemodynamic situation and the survival were studied. Method： A total of 45 head traumatic injury patients admitted in the EICU of General Hospital of Shenyang Military Region from 2009 to 2010 were retrospective analyzed in our study. Pulse indicator continuous cardiac output （PiCCO） was placed in these patients. The Glasgow Coma Scale, APACHE Ⅱ scores, trauma index , hemodynamic data obtained in the beginning and hemodynamic data obtained 24 hours after the PiCCO insertion were recorded and analyzed. The patient＇s outcome on the 14th day after diagnosis was recorded. Result：The overall mortality after 14 day was 36.7%. Such index appeared early in traumatic brain injury patients： high cardiac index and heart rate, global end-diastolic index and extravascular lung water index increased gradually with time, which increased more significantly in death group. The CI and HR was significant higher in survival group and GCS〉8 compared with the death group and GCS≤8（P〈0.05）. Conclusion： In patients with severe traumatic brain injury, rational fluid management may improve the patient＇s survival. Lack of blood flow with reduced tissue oxygenation may contribute to unfavorable outcomes of nonsurvivors.