6%羟乙基淀粉预扩容对颅脑外伤患者围术期血流动力学及炎症因子的影响

The effect of volume expansion with 6% hydroxyethyl starch on perioperative hemodynamics and inflammatory factors in patients with traumatic brain injury

目的：观察6%羟乙基淀粉预扩容对颅脑外伤患者围术期血流动力学及炎症因子的影响。方法：选取2011年1月~2016年6月我院收治的颅脑外伤患者82例作为研究对象,随机分为两组,观察组41例,对照组41例。观察组术前输注6%羟乙基淀粉,对照组术前输注平衡液,观察两组麻醉诱导前（T0）、去颅骨板前（T1）、去颅骨板后5min（T2）、15min（T3）、30min（T4）的血流动力学变化以及术前术后肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）及超敏C反应蛋白（hs-CRP）的变化。结果 ：T0时刻两组心率（HR）、平均动脉压（MAP）以及中心静脉压（CVP）均无统计学差异（P〉0.05）;两组HR在T2时刻均显著上升（P〈0.05）,但T4时刻已恢复至基础值水平（P〉0.05）;两组MAP自T1时刻开始显著下降（P〈0.05）,但观察组下降幅度小于对照组（P〈0.05）;两组CVP从T1时刻至T2时刻先上升再下降（P〈0.05）,但观察组在T4时刻已恢复至基础值水平（P〉0.05）。术前两组TNF-α、IL-6及hsCRP水平无统计学差异（P〉0.05）;术后对照组的TNF-α、IL-6及hs-CRP均显著升高,且高于同期观察组,差异有统计学意义（P〈0.05）。结论：采用6%羟乙基淀粉预扩容颅脑外伤患者有助于维持围术期血流动力学的稳定,降低炎症反应,值得临床借鉴。

Objective： To study the effect of volume expansion with 6 % hydroxyethyl starch on perioperative hemody- namics and inflammatory factors in patients with traumatic brain injury. Methods.. A total of 82 cases of traumatic brain injury from January 2011 to June 2016 in our hospital were randomly divided into the observation group with injection of 6 % hydroxy- ethyl starch and the control group with injection of compound sodium lactate, 41 cases in each group. Hernodynarnics, TNF-α and IL-6 were detected in before induction of anesthesia （TO）, before skull plate （T1）, after skull plate 5 min （T2）, 15 min （T3）, 30 min （T4）. Results： There were no significant differences in CVP, MAP and HR between the two groups at TO time （P〉0.05） ; H R of the two groups of patients were significantly increased （P 〈0.05） at T2, but it was restored to the basal level at T4 （P〉0.05） ; the MAP of the two groups began to decrease significantly at T1 （P〈0.05）, but the observation group was significantly lower than the control group （P〈0.05） ; CVP of the two groups of patients from the T1 time to the T2 time significantly raised first and then declined （P〈0.05）, but the observation group in the T4 time has been restored to the basallevel （P〉0.05）. There was no significant difference in the levels of IL-6 and TNF-α between the two groups before surgery （P 〉0.05） ; after operation, the control group of TNF-α and IL-6 were significantly higher, and higher than the same period of observation group （P〈0.05）. Conclusions： Using 6 % hydroxyethyl starch preloading craniocerebral trauma patients is helpful to maintain the perioperative hemodynamic stability, reduce the level of inflammatory factors, which is worthy of reference.