高容量血液滤过改善重型颅脑损伤患者脑功能的多中心随机对照研究

目的探讨高容量血液滤过（HVHF）对重型颅脑损伤患者颅内压、内环境、脑氧代谢及脑保护作用的影响。 方法采用随机数字表法将114例重型颅脑损伤患者分为常规组和HVHF组，每组各57例。常规组予以甘露醇0.5 g/kg静脉滴注，每6小时1次，连续治疗7 d；HVHF组在常规组的基础上72 h内予以超滤量为60 mL·kg^-1·h^-1的HVHF治疗，持续72 h。记录两组患者的一般资料，治疗前及治疗24 h、72 h、7 d后的颅内压，颈内静脉血氧饱和度（SjvO₂），血清Na⁺浓度，平均动脉压，机械通气时间及ICU住院时间。 结果两组患者各时间点颅内压、血清Na⁺及SjvO₂表达水平比较，差异均有统计学意义（F= 8.159、3.770、2.787，P < 0.001、= 0.011、0.040）；而平均动脉压比较，差异无统计学意义（F= 0.755，P= 0.520）。进一步两两比较发现，常规组患者治疗7 d后颅内压较同组治疗前显著降低（P < 0.05）；HVHF组患者治疗72 h及7 d后颅内压均较同组治疗前和常规组同时间点显著降低（P均< 0.05）；常规组患者治疗72 h及7 d后血清Na⁺和SjvO₂表达水平均较同组治疗前显著升高（P均< 0.05）；HVHF组患者治疗24 h、72 h及7 d后血清Na⁺表达水平均较常规组同时间点显著降低（P均< 0.05），治疗72 h及7 d后SjvO₂表达水平均较同组治疗前和常规组同时间点显著升高（P均< 0.05）。两组患者机械通气时间（13.5 ± 3.3）d vs.（12.5 ± 2.6）d]和住ICU时间（18 ± 6）d vs.（16 ± 5）d]比较，差异均无统计学意义（t = 1.797、1.599，P = 0.075、0.113）。 结论HVHF可有效改善重型颅脑损伤患者颅内压及脑代谢水平，具有脑保护和稳定内环境的作用。

High volume hemofiltration to improve brain function in patients with severe craniocerebral injury: a multicenter randomized controlled trial

ObjectiveTo investigate the effects of high volume hemofiltration (HVHF) on intracranial pressure, internal environment, cerebral oxygen metabolism and brain protection in patients with severe craniocerebral injury. MethodsTotally 114 patients with severe craniocerebral injury were divided into the routine group (57 cases) and HVHF group (57 cases) by the random number table method. The routine group was treated with 0.5 g/kg mannitol intravenously once every 6 hours for 7 days. The HVHF group was treated with HVHF with an ultrafiltration dose of 60 mL·kg^-1·h^-1 for 72 h on the basis of the routine group. The intracranial pressure, internal jugular venous oxygen saturation (SjvO₂), serum Na⁺ concentration, mean arterial pressure, mechanical ventilation time and hospitalization time of ICU were recorded before and 24 h, 72 h, 7 d after treatment in these two groups. ResultsThere were significant differences in intracranial pressure, serum Na⁺ and SjvO₂ levels between these two groups (F = 8.159, 3.770, 2.787; P < 0.001, = 0.011, 0.040) and there was no significant difference in mean arterial pressure (F = 0.755, P = 0.520). Further pairwise comparison showed that the intracranial pressure in the routine group on 7 days after treatment was significantly lower than that in the same group before treatment (P < 0.05), while the intracranial pressure in the HVHF group decreased significantly at 72 h and 7 d after treatment compared with that in the same group before treatment and at the same time point in the routine group (all P < 0.05). The levels of serum Na⁺ and SjvO₂ at 72 h and 7 d after treatment in the routine group were all significantly higher than those in the same group before treatment (all P < 0.05). The level of serum Na⁺ in the HVHF group was significantly lower than that in the routine group at 24 h, 72 h and 7 d after treatment (all P < 0.05). The expression of SjvO₂ at 72 h and 7 d after treatment was significantly higher than that in the same group before treatment and at the same time point in the routine group (all P < 0.05). There were no significant differences between these two groups in mechanical ventilation time (13.5 ± 3.3) d vs. (12.5 ± 2.6) d] and hospitalization time of ICU (18 ± 6) d vs. (16 ± 5) d] (t = 1.797, 1.599; P = 0.075, 0.113). ConclusionHVHF can effectively improve intracranial pressure and brain metabolism in patients with severe craniocerebral injury, which can protect the brain and stabilize the internal environment.