目标导向容量联合右美托咪定对颅脑损伤患者血流动力学影响及脑保护作用评价

  目的  探讨围术期应用目标导向容量治疗联合右美托咪定对创伤性颅脑损伤患者血流动力学的影响及脑保护作用，为临床医师选择治疗方式提供依据。  方法  将南通大学附属海安医院2018年8月—2020年8月期间于重症监护室住院治疗的70例创伤性颅脑损伤患者纳入研究，按照随机数字表法分为观察组和对照组，每组35例。2组患者均采用目标导向容量治疗，观察组患者麻醉诱导采用右美托咪定持续静脉泵注，对照组则应用生理盐水，密切观察并记录2组患者麻醉诱导后(T0)、开硬脑膜时(T1)、关硬脑膜时(T2)、手术结束时(T3)的心率(HR)、平均动脉压(MAP)及血清S100β水平，术前、术后7 d的格拉斯哥昏迷评分(GCS)评分。  结果  2组患者T0时刻HR、MAP、血清S100β水平之间差异无统计学意义(均P＞0.05)；观察组T1、T2、T3时刻的HR、MAP、血清S100β水平均低于对照组(均P＜0.05)；2组患者术前GCS评分差异无统计学意义(P＞0.05)；术后7 d观察组患者GCS评分显著高于对照组[(13.21±1.04)分vs.(11.01±1.55)分，P＜0.05]。  结论  围术期应用目标导向容量联合右美托咪定治疗创伤性颅脑损伤患者，能够维持患者脑血流动力学稳定，更好地保护脑功能。 

Effect of goal-directed volume combined with dexmedetomidine on hemodynamics and brain protection in patients with craniocerebral injury

  Objective  To evaluate the effect of goal-directed fluid therapy combined with dexmedetomidine in the perioperative period on haemodynamics and brain protection in patients with traumatic craniocerebral injury, so as to provide a basis for clinicians to choose treatment methods.  Methods  A total of 70 patients with traumatic craniocerebral injury admitted in our hospital from August 2018 to August 2020 were enrolled by convenience sampling method. According to the random number table method, they were divided into the observation group and control group, with 35 patients in each group. Both groups were treated with goal-directed fluid therapy. Patients in the observation group were induced by continuous intravenous infusion of dexmedetomidine, while patients in the control group were treated with normal saline. Anaesthesia induction (T0), open the dura (T1), close the dura (T2), the end of surgery (T3) of heart rate (HR), mean arterial pressure (MAP) and the level of serum S100β, GCS score of preoperative and 7 days after operation were closely observed and recorded.  Results  No statistically significant difference was observed between both groups in terms of gender, age, BMI, ASA classification and other general information (all P>0.05). Moreover, no significant difference was found in the HR, MAP and serum S100β levels between both groups at T0 (all P>0.05). The HR, MAP and serum S100β levels in the observation group were lower than those in the control group at T1, T2 and T3 (all P < 0.05). No difference was observed in the preoperative GCS score between both groups (P>0.05). The GCS score of the observation group was significantly higher than that of the control group 7 days after the operation [(13.21±1.04)points vs. (11.01±1.55) points, P < 0.05].  Conclusion  The application of goal-directed fluid therapy combined with dexmedetomidine in perioperative treatment of patients with traumatic craniocerebral injury can maintain the stability of cerebral haemodynamics, better protect brain function and has a broad clinical application prospect.