等容血液稀释联合控制性降压对颅脑手术患者神经功能的影响

Effect of isovolemic hemodilution combined with controlled hypotension on neurological function in patients undergoing craniocerebral operation

目的:研究等容血液稀释联合控制性降压对颅脑外伤手术患者神经功能保护的价值。方法:选取138例行颅脑外伤手术患者,用数字随机原则分为对照组和观察组各69例,对照组术中采用控制性降压技术,观察组联合使用等容血液稀释和控制性降压技术,比较两组患者的疗效和预后效果。结果:全麻插管后(T0)两组患者血流动力学指标、脑组织氧代谢指标差异无统计学意义;控制降压前(T1)、控制降压30 min时(T2)、血肿清除后(T3)及手术结束时(T4)等时段组间CVP、MAP、HR差异有统计学意义;观察组GOS优良率高于对照组;组间不良反应发生率差异无统计学意义。结论:等容血液稀释联合控制性降压在颅脑外伤手术中的应用可确保脑组织血氧供应,保护脑神经,提升预后效果。

Objective:To study the effect of isovolemic hemodilution combined with controlled antihypertension on the protection of neurological function in patients with craniocerebral trauma.Methods:A total of 138 patients with craniocerebral trauma were enrolled and divided into a control group and an observation group with 69 cases each based on the digital randomization principle.The control group underwent only controlled antihypertensive treatment while the observation group was treated with isovolemic hemodilution and controlled antihypertensive therapy.The treatment efficacy and prognosis were compared between the two groups.Results:There were no significant differences between the two groups in the indicators of hemodynamic parameters and brain tissue oxygen metabolism after intubation(T0)(P>0.05).However,there were significant differences between the two groups in CVP,MAP and HR before the controlled antihypertensive treatment(T1),at 30 minutes after the controlled antihypertensive treatment(T2),after hematoma removal(T3)and the end of surgery(T4)(P<0.05).The excellent rate of GOS was higher in the observation group than the control group(P<0.05).There were no significant differences between the two groups in the incidence of adverse reactions(P>0.05).Conclusion:The application of isovolemic hemodilution combined with controlled antihypertension in craniocerebral trauma surgery can ensure the blood supply to the brain tissue,protect the brain nerve and improve the prognosis.