| 汪 浩,刁文波,王 进,雷鹏飞,梅闪闪.控制性低温麻醉联合PiCCO监测对创伤性失血性休克患者的脑组织灌注和耗氧量的影响[J].,2022,(16):3065-3069 |
| 控制性低温麻醉联合PiCCO监测对创伤性失血性休克患者的脑组织灌注和耗氧量的影响 |
| Effect of Controlled Hypothermia Anesthesia Combined with PICCO Monitoring on Brain Tissue Perfusion and Oxygen Consumption in Patients with Traumatic Hemorrhagic Shock |
| 投稿时间：2021-12-06 修订日期：2021-12-31 |
| DOI：10.13241/j.cnki.pmb.2022.16.014 |
| 中文关键词: 控制性低温 PICCO 创伤性失血性休克 脑组织灌注 耗氧量 |
| 英文关键词: Controlled hypothermia PICCO Traumatic hemorrhagic shock Brain tissue perfusion Oxygen consumption |
| 基金项目:广东省医学科学技术研究基金项目（A2019030） |
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| 中文摘要: |
| 摘要 目的：探讨控制性低温麻醉联合脉搏指数轮廓心输出量（PiCCO）监测对创伤性失血性休克患者的脑组织灌注和耗氧量的影响。方法：前瞻性选择2018年7月至2021年11月期间入住我院急诊重症监护病房的120名创伤性失血性休克患纳入本研究。根据随机数字表法，分为常温组（常温麻醉联合PiCCO监测）和低温组（控制性低温麻醉联合PiCCO监测）。PiCCO同时测量的心输出量（CO）和心脏指数（CI）。统计创伤性失血性休克患者耗氧量。通过动脉导管或血压袖带测量平均动脉压（MAP）。使用EVD测量颅内压（ICP）。脑灌注压为MAP和ICP之间的差值。通过Armstrong和 Al-Awadi方法测量MDA水平。通过分光光度方法测量NO水平。通过恒流过滤器系统测量ED指数。通过ELISA测量Caspase-3、Caspase-9、IL-6和IL-8的水平。对创伤性失血性休克患者急性呼吸窘迫综合征（ARDS）、多脏器功能衰竭（MODS）和死亡率统计。结果：低温组CO和CI较常温组升高（P<0.05）。低温组干预前DO2、VO2和SvO2与常温组比较无统计性差异（P>0.05）。低温组与常温组干预后DO2、VO2和SvO2均较干预前升高（P<0.05）。低温组干预后DO2、VO2和SvO2较常温组升高（P<0.05）。低温组0 h脑灌注压与常温组比较无统计性差异（P>0.05）。低温组1 h、2 h和3 h脑灌注压较常温组升高（P<0.05）。低温组MDA、NO和ED较常温组降低（P<0.05）。低温组Caspase-3、Caspase-9、IL-6和IL-8水平较常温组降低（P<0.05）。低温组ARDS、MODS和死亡率较常温组降低（P<0.05）。结论：控制性低温麻醉联合PICCO监测通过调节细胞凋亡途径和炎症因子分泌，增加创伤性失血性休克患者脑组织灌注和耗氧量，降低患者ARDS、MODS发生率和死亡率。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effect of controlled hypothermia anesthesia combined with Pulse Index Contour Cardiac Output (PICCO) monitoring on brain tissue perfusion and oxygen consumption in patients with traumatic hemorrhagic shock. Methods: Prospectively selected 120 patients with traumatic hemorrhagic shock who were admitted to the emergency intensive care unit of our hospital from July 2018 to November 2021 for inclusion in this study. According to the random number table method, they were divided into a normal temperature group (normal temperature anesthesia combined with PiCCO monitoring) and a hypothermia group (controlled hypothermic anesthesia combined with PiCCO monitoring). Cardiac output (CO) and cardiac index (CI) measured by PICCO at the same time. Statistics of oxygen consumption in patients with traumatic hemorrhagic shock. Mean arterial pressure (MAP) is measured by arterial catheter or blood pressure cuff. ICP is measured by using EVD. CPP is the difference between MAP and ICP. MDA level was measured by Armstrong and Al-Awadi method. The NO level is measured by spectrophotometric method. The ED index is measured by a constant current filter system. The levels of Caspase-3, Caspase-9, IL-6 and IL-8 were measured by ELISA. Statistics on acute respiratory distress syndrome (Acute respiratory distress syndrome, ARDS), multiple organ failure (MODS) and mortality in patients with traumatic hemorrhagic shock. Results: CO and CI in the low temperature group were higher than those in the normal temperature group(P<0.05). There was no statistical difference in DO2, VO2 and SvO2 between the low temperature group and the normal temperature group before intervention(P>0.05). The DO2, VO2 and SvO2 of the hypothermia group and the normal temperature group increased after intervention (P<0.05). DO2, VO2 and SvO2 in the hypothermia group were higher than those in the normal temperature group after intervention (P<0.05). There was no statistical difference in 0h cerebral perfusion pressure between the hypothermia group and the normal temperature group (P>0.05). The cerebral perfusion pressure of 1 h, 2 h and 3 h in the hypothermia group was higher than that in the normal temperature group (P<0.05). MDA, NO and ED in the hypothermia group were lower than those in the normal temperature group (P<0.05). The levels of Caspase-3, Caspase-9, IL-6 and IL-8 in the low temperature group were lower than those in the normal temperature group (P<0.05). ARDS, MODS and mortality in the hypothermia group were lower than those in the normal temperature group(P<0.05). Conclusion: Controlled hypothermia anesthesia combined with PICCO monitoring can increase brain tissue perfusion and oxygen consumption in patients with traumatic hemorrhagic shock, and reduce the incidence and mortality of ARDS and MODS by regulating the pathway of apoptosis and the secretion of inflammatory factors. |
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