术中使用高渗盐水对四肢多发骨折失血性休克患者脑功能的影响及脑保护作用

Effects of hypertonic saline on brain function and brain protection of hemorrhagic shock caused by multiple fractures of extremities during operation

目的探讨术中使用高渗盐水对四肢多发骨折失血性休克患者脑功能的影响及脑保护作用。方法选择2015年6月至2017年6月本院收治的四肢骨折合并失血性休克患者112例,按照随机数字法分为两组,各56例。对照组使用羟乙基淀粉130/0.4及乳酸林格氏液,观察组静脉给予3.0%高渗盐水6 m L/kg。比较两组干预后血浆电解质水平,两组干预前、后血浆渗透压变化,两组患者颅内压和脑灌注压变化情况,术后12 h两组欧洲脑卒中评分(ESS)和简易精神状态量表(MMSE)评分。结果观察组钠离子及氯离子水平高于对照组,钾离子水平低于对照组(P<0.05);干预后30 min、2 h、12 h,观察组血浆渗透压均显著高于对照组(P<0.05);观察组脑氧分压与脑灌注压均显著高于对照组(P<0.05);术后12 h,观察组ESS及MMSE评分均明显高于对照组(P<0.05)。结论 3.0%高渗盐水治疗四肢多发骨折所致失血性休克,能有效维持电解质平衡,提高血浆渗透压,改善脑组织氧供,提高脑灌注压,从而改善患者术后神经系统功能,起到一定的脑保护作用。

Objective To investigate the effects of hypertonic saline on brain function and brain protection ofhemorrhagic shock caused by multiple fractures of extremities during operation. Methods A total of 112 patients with limbfractures combined with hemorrhagic shock in our hospital from June 2015 to June 2017 were selected and divided into twogroups according to the random number method, with 56 cases in each group. The control group was treated withhydroxyethyl starch 130/0.4 and lactic acid Ringer＇s solution, and the observation group was given 3.0% hypertonic saline6 mL/kg intravenously. The levels of plasma electrolyte after intervention of both groups were compared. The changes ofplasma osmolality before and after intervention in the two groups were compared. The changes of intracranial pressure andcerebral perfusion pressure, European stroke scores （ESS） and mini mental state examination （MMSE） scores at 12h aftersurgery of both groups were compared. Results The levels of sodium ions and chloride ions in the observation group werehigher than those in the control group and the level of potassium ions was lower than that of the control group （P〈0.05）.After 30 min, 2 h, 12h after intervention, the cerebral oxygen partial pressure of the observation group were significantlyhigher than those of the control group（P〈0.05）. The cerebral perfusion pressure and intracranial pressure of the observationgroup were significantly higher than those of the control group （P〈0.05）. The ESS and MMSE scores of the observationgroup were significantly higher than those of the control group at 12 h after surgery （P〈0.05）. Conclusion Three percenthypertonic saline can effectively maintain the electrolyte balance, improve the plasma osmotic pressure, the oxygen supplyin the brain tissue and the cerebral perfusion pressure, so as to improve the neurological function of the patients withhemorrhagic shock caused by multiple fractures of the limbs, with certain brain protection.