| 孟建标,赖志珍,胡马洪,许秀娟,季春莲.高容量血液滤过对重型颅脑损伤患者脑保护作用的研究[J].浙江中西医结合杂志,2018,28(3): |
| 高容量血液滤过对重型颅脑损伤患者脑保护作用的研究 |
| Study on the protective effect of HVHF in the treatment of Severe brain trauma |
| 投稿时间：2017-06-12 修订日期：2018-01-11 |
| DOI： |
| 中文关键词: 高容量血液滤过 重型脑损伤 脑氧代谢 |
| 英文关键词:HVHF Severe brain injury Cerebral metabolism CERO2 |
| 基金项目:浙江省科技厅公益性技术应用研究(No. 2013C33G5260034) |
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| 中文摘要: |
| 目的 探讨高容量血液滤过（HVHF）对重型颅脑损伤患者脑氧代谢及脑保护作用的影响。方法 将68例行去骨瓣减压术后持续行机械通气的重型颅脑损伤患者随机分为常规组和HVHF组进行前瞻性非盲随机对照研究，每组均为34例。常规组予以甘露醇0.5g/kg静滴，每4小时一次；HVHF组在常规治疗的基础上予以超滤量为60ml/kg.h的HVHF治疗，持续72小时。治疗期监测两组患者治疗前及治疗后72h测定患者的脑SjVO2、Da-jvO2、CERO2、血清S-100β蛋白和NSE水平变化。结果 治疗组与对照组在治疗前的SjVO2、Da-jvO2、CERO2、血清S-100β蛋白以及NSE水平分别为[（62±13）%比（65±12）%、（51±24）ml/L比（58±31）ml/L、（36±15）%比（38±16）%、（6.15±1.63）μg/L比（6.24±1.78）μg/L以及（24.57±4.23）μg/L比（25.22±3.98）μg/L]。治疗组与对照组在治疗后72时的SjVO2、Da-jvO2、CERO2、血清S-100β蛋白以及NSE水平分别为[（84±16）%比（72±15）%、（30±12）ml/L 比（40±16）ml/L、（19±11）% 比 （27±12）%、（3.11±1.05）μg/L 比（5.43±1.29）μg/L以及（11.92±3.35）μg/L比（23.39±2.20）μg/L]。与治疗前比较，两组患者治疗后的Da-jvO2、CERO2、血清S-100β蛋白以及NSE水平均明显降低，SjVO2水平均有升高。治疗后与对照组比较，治疗组的Da-jvO2、CERO2、血清S-100β蛋白以及NSE水平均明显低于对照组，SjVO2水平明显高于对照组，以上结果差异均有统计学意义（P＜0.05）。结论 与常规治疗相比较，HVHF能有效降低了重型颅脑损伤患者脑代谢水平，具有脑保护作用。 |
| 英文摘要: |
| Objective To investigate the effect of HVHF in the treatment of Severe trauma in Cerebral metabolism and the protective effect of brain. Methods 68 cases of severe brain trauma were selected and randomly divided into 2 groups, The control group(n=34) was given conventional treatment,and the treatment group (n=34) was given HVHF treatment in addition to the conventional therapy．The SjVO2, Da-jvO2, CERO2, levels of serum S-100β and NSE were compared before and after treatment in two groups. Results Before treatment, the levels of SjVO2、Da-jvO2、CERO2、S-100β and NSE between treatment group and control group were respectively [(62±13)% vs (65±12)%、(51±24)ml/L vs (58±31)ml/L、(36±15)% vs (38±16)%、(6.15±1.63)μg/L vs (6.24±1.78)μg/L and (24.57±4.23)μg/L vs (25.22±3.98)μg/L]. At the 72ed hour after treatment, the levels of SjVO2、Da-jvO2、CERO2、S-100β and NSE between treatment group and control group were respectively [(84±16)% vs (72±15)%、(30±12)ml/L vs (40±16)ml/L、(19±11)% vs (27±12)%、(3.11±1.05)μg/L vs (5.43±1.29)μg/L and (11.92±3.35)μg/L vs（23.39±2.20)μg/L]. Compared with before treatment, levels of Da-jvO2, serum CERO2, S-100 and NSE protein in two groups of patients after treatment decreased, and level of SjVO2 increased(P<0.05), compared with the control group, levels of Da-jvO2, serum CERO2, S-100 and NSE protein in the experiment group were lower, the levels of SjVO2 were higher, the differences were statistically significant (P<0.05). Conclusion HVHF can effectively reduce the level of cerebral metabolism and protect the function of brain in patients with severe traumatic injury. |
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