颅脑创伤患者术中液体管理的研究进展

Advances in intraoperative fluid management in patients with traumatic brain injury

颅脑创伤(traumatic brain injury, TBI)患者术中维持适宜的血容量对预后有很大影响。有研究表明液体超负荷可导致组织水肿、肺损伤和创面愈合不良等并发症,液体量不足会增加低血压风险,减少心、脑、肾等重要器官灌注,甚至导致器官功能衰竭。如何优化术中液体管理策略是麻醉科医师最常见问题之一。文章从液体选择(晶体液、胶体液、高渗盐水和甘露醇)、液体用量[开放性液体治疗、限制性液体治疗、目标导向液体治疗(goal directed fluid therapy, GDFT)]、血管内容量状态监测三个方面进行了总结,阐述不同的液体管理策略,以期为TBI患者术中液体管理提供指导并为新的相关研究提供参考。

An appropriate blood volume has a great influence on the prognosis of patients with traumatic brain injury(TBI).Studies have shown that fluid overload leads to complications such as tissue edema,lung injury and poor wound healing.Insufficient fluid increases the risk of hypotension,reduces perfusion of vital organs such as the heart,brain,and kidney,even leads to organ failure.How to optimize the intraoperative fluid management strategy is one of the most common problems for anesthesiologists.This article will discuss the three aspects:Liquid properties(crystalloid,colloid,hypertonic saline,and mannitol),liquid dosage[open fluid therapy,restricted fluid therapy,goal directed fluid therapy(GDFT)],Intravascular volume monitoring.Addressing the advantages and disadvantages of different fluid management strategies aims to guide intraoperative fluid management in TBI patients and provide references for new studies.