| 宋 怡,陈正钢,李恒涛,何智勇,彭国兵.使用机械通气联合限制性液体复苏对重度颅脑损伤患者的急救效果及对远期认知功能影响[J].,2023,(13):2466-2471 |
| 使用机械通气联合限制性液体复苏对重度颅脑损伤患者的急救效果及对远期认知功能影响 |
| The Effect of Using Mechanical Ventilation Combined with Rrestrictive Fluid Resuscitation on the Resuscitation of Patients with Severe Craniocerebral Injury and the Effect on Long-term Cognitive Function |
| 投稿时间：2023-02-06 修订日期：2023-02-28 |
| DOI：10.13241/j.cnki.pmb.2023.13.013 |
| 中文关键词: 机械通气 限制性液体复苏 重度颅脑损伤 急救效果 |
| 英文关键词: Mechanical ventilation Restrictive fluid resuscitation Severe craniocerebral injury Emergency outcome |
| 基金项目:江苏省自然科学基金面上研究项目（BK2018341） |
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| 中文摘要: |
| 摘要 目的：探讨使用机械通气联合限制性液体复苏对重度颅脑损伤患者的急救效果及对远期认知功能影响。方法：选取我院2020年1月到2022年12月急诊收治的90例重度颅脑损伤患者作为研究对象，应用随机数字表法将所有患者分为观察组与对照组，每组45例。所有患者均采取常规重型颅脑损伤治疗，对照组患者在损伤后立即给予机械通气，并采取常规液体复苏措施进行治疗。观察组在损伤后立即给予机械通气，并采取限制性液体复苏治疗，对比两组患者急救效果，急救治疗前与急救治疗后1 h的血气指标变化情况，急救治疗前与急救治疗后1 d的血尿素氮（BUN）、血清肌酐（Scr）、乳酸、肌酸激酶（CK）相关生化指标表达水平，最后分别在患者苏醒时、术后3 d、6 d、10 d检测两组患者S100B蛋白与褪黑素表达水平。结果：观察组患者苏醒时间、说话时间、总输液量以及死亡率明显低于对照组，观察组GOS评分明显高于对照组（P＜0.05）；治疗前两组患者血氧饱和度（SpO2）、动脉血二氧化碳分压（PaCO2）水平对比无明显差异（P＞0.05），治疗后，对照组SpO2水平降低，观察组无明显变化，两组患者PaCO2水平均降低，且观察组低于对照组（P＜0.05）；治疗前两组患者BUN、Scr、乳酸、CK相关指标表达水平对比无明显差异（P＞0.05），治疗后对照组患者CK水平升高，观察组无明显变化，且观察组明显低于对照组，BUN、Scr、乳酸水平均降低，且观察组明显低于对照组（P＜0.05）；两组患者苏醒时S100B 蛋白、褪黑素对比无明显差异（P＞0.05），术后3 d、6 d、10 d S100B 蛋白明显降低，且观察组低于对照组，术后3 d、6 d、10 d褪黑素明显升高，观察组高于对照组（P＜0.05）。结论：使用机械通气联合限制性液体复苏能够提升重度颅脑损伤患者的急救效果，降低患者死亡率，且能够及时改善患者血氧饱和度、动脉血二氧化碳分压相关血气指标水平，减轻对患者心功能、肾功能带来的损伤，同时能够降低对患者神经功能产生的损伤情况。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the effect of using mechanical ventilation combined with restrictive fluid resuscitation on the resuscitation of patients with severe craniocerebral injury and the effect on long-term cognitive function. Methods: Ninety patients with severe craniocerebral injury admitted to the emergency department of our hospital from January 2020 to December 2022 were selected as study subjects, and the random number table method was applied to divide all patients into observation and control groups, with 45 cases in each group. All patients were treated with conventional heavy craniocerebral injury, and patients in the control group were given mechanical ventilation immediately after injury and treated with conventional fluid resuscitation measures. In the observation group, mechanical ventilation was given immediately after the injury and restrictive fluid resuscitation was taken, and the effect of first aid, changes in blood gas indexes before and 1 h after emergency treatment, blood urea nitrogen (BUN), serum creatinine (Scr) before and 1 d after emergency treatment were compared between the two groups. The expression levels of blood urea nitrogen (BUN), serum creatinine (Scr), lactate, creatine kinase (CK), and finally S100B protein and melatonin were measured at the time of awakening, 3 d, 6 d and 10 d after the operation. Results: The patients in the observation group had significantly lower awakening time, speaking time, total infusion volume and mortality rate than the control group, and the GOS score of the observation group was significantly higher than that of the control group (P<0.05); There was no significant difference in the comparison of blood oxygen saturation (SpO2) and arterial blood carbon dioxide partial pressure (PaCO2) levels between the two groups before treatment(P<0.05), after treatment, the SpO2 level decreased in the control group and there was no significant change in the observation group, PaCO2 levels decreased in both groups, and the observation group was lower than the control group(P<0.05). Before treatment, there was no significant difference between the expression levels of BUN, Scr, lactate and CK related indexes in the two groups(P＞0.05), after treatment, the CK level increased in the control group, but there was no significant change in the observation group, and the observation group was significantly lower than the control group, and the levels of BUN, Scr and lactate were reduced, and the observation group was significantly lower than the control group(P＜0.05). There was no significant difference in the comparison of S100B protein and melatonin at awakening between the two groups (P>0.05), and S100B protein decreased significantly at 3 d, 6 d and 10 d after surgery and was lower in the observation group than in the control group, and melatonin increased significantly at 3 d, 6 d and 10 d after surgery and was higher in the observation group than in the control group(P<0.05). Conclusion: The use of mechanical ventilation combined with restrictive fluid resuscitation can improve the emergency effect of patients with severe craniocerebral injury, reduce the mortality rate of patients, and improve the level of oxygen saturation and partial pressure of arterial blood carbon dioxide, reduce the damage to the patient's cardiac and renal functions, and reduce the damage to the patient's neurological functions. |
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