高容量血液滤过对重型颅脑损伤患者颅内压及血流动力学影响.docVIP

高容量血液滤过对重型颅脑损伤患者颅内压及血流动力学影响 　　[摘要] 目的 观察高容量血液滤过（HVHF）对重型颅脑损伤患者颅内压及血流动力学的影响。 方法 选取90例广泛脑挫裂伤、脑干损伤或颅内血肿、GCS评分3～8分的患者，按治疗方法的不同分为治疗组60例与对照组30例，对照组给予颅脑手术、甘露醇脱水降颅内压等常规治疗措施，治疗组在此基础上给予HVHF治疗，观察两组患者颅内压及心率（HR）、平均动脉压（MAP）、心排指数（CI）变化。 结果 治疗组1 d、3 d、5 d及7 d颅内压（ICP）明显低于对照组（P0.05），治疗组在治疗后24 h心率（HR）明显低于对照组（P0.05），平均动脉压（MAP）、心排指数（CI）明显高于对照组，差异具有统计学意义（P0.05）。 结论 HVHF治疗可显著降低重型颅脑损伤患者颅内压增高曲线，更有利于维持重型颅脑损伤患者血流动力学稳定。 　　[关键词] 重型颅脑损伤；高容量血液滤过；颅内压；血流动力学 　　[中图分类号] R651.15 [文献标识码] A [文章编号] 1673-9701（2017）08-0024-04 　　[Abstract] Objective To observe the effect of high volume hemofiltration （HVHF） on intracranial pressure and hemodynamics in the patients with severe craniocerebral injury. Methods A total of 90 patients with extensive brain contusion， brain stem injury or intracranial hematoma and GCS score of 3 to 8 were divided into the treatment group（60 cases） and the control group （30 cases） according to different treatment methods. The control group was given craniotomy， mannitol dehydration to lower the intracranial pressure and other conventional treatment measures， and the treatment group was given HVHF on the basis of the control group. The changes of intracranial pressure and heart rate（HR）， mean arterial pressure（MAP） and cardiac index（CI） were observed in two groups. Results The intracranial pressure （ICP） in the treatment group was significantly lower than that in the control group at 1 d， 3 d， 5 d and 7 d（P0.05）. The 24 h heart rate （HR） in the treatment group after the treatment was significantly lower than that in the control group（P0.05）. The mean arterial pressure（MAP） and cardiac index（CI） were significantly higher than those in the control group， and the differences were statistically significant（P0.05）. Conclusion HVHF can significantly reduce the increase curve of intracranial pressure in the patients with severe craniocerebral injury， and it is more effective in maintaining hemodynamic stability in patients with severe craniocerebral injury. 　　[Key words] Severe cranioc