血压调控联合完全机械通气治疗重症颅脑损伤的临床研究

Clinical Study of Blood Pressure Regulation Combined with Full Mechanical Ventilation in the Treatment of Severe Traumatic Brain Injury

目的探究血压调控联合完全机械通气在重症颅脑损伤中的应用价值。方法将南阳市中心医院2021年10月至2023年10月收治的82例重症颅脑损伤患者作为本次研究对象,以随机数字表法作为本次研究分组方案,将患者分为两组,各41例,对照组接受常规治疗,试验组在对照组的基础上接受血压调控联合完全机械通气治疗,比较两组患者颅内压、神经元特异性烯醇化酶(NSE)、脑氧代谢指标与预后情况。结果治疗前,两组患者颅内压与NSE水平对比差异无统计学意义(P>0.05),在治疗后,两组颅内压均降低,NSE水平均升高,其中试验组颅内压与NSE水平均低于对照组,差异具有统计学意义(P<0.05)。两组患者治疗前脑氧代谢各指标水平对比差异无统计学意义(P>0.05),治疗后,两组脑组织氧分压、脑氧含量、颈内静脉血氧含量数值均升高,动脉-颈内静脉球部血氧差、脑氧摄取率数值均降低,其中试验组脑组织氧分压、脑氧含量、颈内静脉血氧含量高于对照组,动脉-颈内静脉球部血氧差、脑氧摄取率数值均低于对照组,差异具有统计学意义(P<0.05)。试验组恢复良好与中度残疾数较对照组多,其整体预后情况较对照组好,差异具有统计学意义(P<0.05)。结论重症颅脑损伤患者接受血压调控联合完全机械通气治疗后,其颅内压、NSE水平与脑氧代谢指标水平较优,预后情况理想,值得临床应用。

Objective To investigate the clinical value of blood pressure regulation combined with full mechanical ventilation in the treatment of severe traumatic brain injury.Methods A total of 82 patients with severe traumatic brain injury treated at Nanyang Central Hospital from October 2021 to October 2023 were selected as study subjects.Using a random number table method,patients were divided into two groups,with 41 cases in each group.The control group received routine treatment,while the experimental group received blood pressure regulation combined with full mechanical ventilation.Intracranial pressure,neuron-specific enolase(NSE),cerebral oxygen metabolism indicators,and prognosis were compared between the two groups.Results Before treatment,there were no significant differences in Intracranial pressure and NSE levels between the two groups(P>0.05).After treatment,both groups showed decreased Intracranial pressure and increased NSE levels,with the experimental group showing lower Intracranial pressure and NSE levels compared to the control group(P<0.05).Before treatment,there were no significant differences in cerebral oxygen metabolism indicators between the two groups(P>0.05).After treatment,both groups showed increased cerebral tissue oxygen pressure,cerebral oxygen content,and internal jugular venous oxygen content,and decreased arterio-jugular venous oxygen difference and cerebral oxygen uptake rate,with the experimental group showing better results compared to the control group(P<0.05).The experimental group had more patients with good recovery and moderate disability compared to the control group,and overall prognosis was better in the experimental group(P<0.05).Conclusion Blood pressure regulation combined with full mechanical ventilation significantly improves Intracranial pressure,NSE levels,and cerebral oxygen metabolism indicators in patients with severe traumatic brain injury,leading to better prognosis.It is worth clinical application.