目标导向液体治疗联合右美托咪定对创伤性颅脑损伤患者血流动力学、脑氧代谢及炎症因子的影响

目的:探讨目标导向液体(GDFT)治疗联合右美托咪定对创伤性颅脑损伤(TBI)患者血流动力学、脑氧代谢及炎症因子的影响。方法:选取2016年3月~2019年3月期间我院收治的TBI患者142例,根据随机数字表法分为对照组1(n=47,GDFT治疗)、对照组2(n=47,常规液体联合右美托咪定)和研究组(n=48,GDFT联合右美托咪定),比较三组患者围术期指标、血流动力学、脑氧代谢及炎症因子变化情况,记录三组围术期间不良反应状况。结果:三组患者术后12、24 h心率(HR)、呼吸频率(RR)及动脉-颈内静脉血氧含量差(AVDO2)均较术前降低,且研究组低于对照组1、对照组2(P<0.05);三组患者术后12、24 h血氧饱和度(Sjv O2)较术前升高,且研究组高于对照组1、对照组2(P<0.05);三组患者术后12、24 h白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)呈逐渐下降趋势(P<0.05);研究组术后12、24 h的IL-6、TNF-α低于对照组1、对照组2(P<0.05)。对照组2、对照组1、研究组术中总液体量、胶体量、晶体量依次减少(P<0.05),住院天数依次缩短(P<0.05)。三组不良反应发生率对比未见显著差异(P>0.05)。结论:TBI患者手术麻醉过程中给予GDFT联合右美托咪定方案,促进机体HR、RR趋于平稳的同时还可改善脑氧代谢及炎性因子水平,且不增加不良反应发生率。

Effects of Target Directed Liquid Therapy Combined with Dexmedetomidine on Hemodynamics, Cerebral Oxygen Metabolism and Inflammatory Factors in Patients with Traumatic Brain Injury

Objective: To investigate the effects of target directed fluid therapy(GDFT) combined with dexmedetomidine on hemodynamics, cerebral oxygen metabolism and inflammatory factors in patients with traumatic brain injury(TBI). Methods: A total of142 patients with TBI who were admitted to our hospital from March 2016 to March 2019 were selected, they were randomly divided into control group 1(n=47, GDFT treatment), control group 2(n=47, routine liquid combined with dexmedetomidine) and study group(n=48, GDFT combined with dexmedetomidine). The perioperative indexes, hemodynamics, cerebral oxygen metabolism and inflammatory factors changes were compared. The adverse reactions of the three groups during perioperative period were recorded. Results: The heart rate(HR), respiratory rate(RR) and blood oxygen content difference between artery and internal jugular vein(AVDO2) in the three groups at 12 and 24 hours after operation were all decreased compared with the before operation, and those in the study group were lower than those in the control group 1 and control group 2(P<0.05). The blood oxygen saturation(Sjv O2) of the three groups at 12 and 24 hours after operation increased, and those in the study group were higher than those in the control group 1 and control group 2(P<0.05).The levels of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) of the three groups at 12 and 24 hours after operation were decreased(P<0.05). The levels of IL-6 and TNF-α in the study group at 12 and 24 hours were lower than those in the control group 1 and control group 2(P<0.05). The total fluid volume, colloid volume and crystal volume decreased successively in control group 2, control group 1 and study group(P<0.05), and the length of stay in hospital decreased in turn(P<0.05). There was no significant difference in the incidence of adverse reactions in the three groups(P>0.05). Conclusion: During the surgical anesthesia of TBI patients, GDFT combined with dexmedetomidine regimen can promote the stability of human HR and RR, and improve the level of cerebral oxygen metabolism and inflammatory factors, and it do not increase the incidence of adverse reactions.