耿极光 姚宝军 荆鸿道

摘 要 目的：研究等容血液稀释联合控制性降压对颅脑外伤手术患者神经功能保护的价值。方法：选取138例行颅脑外伤手术患者，用数字随机原则分为对照组和观察组各69例，对照组术中采用控制性降压技术，观察组联合使用等容血液稀释和控制性降压技术，比较两组患者的疗效和预后效果。结果：全麻插管后（T0）两组患者血流动力学指标、脑组织氧代谢指标差异无统计学意义；控制降压前（T1）、控制降压30 min时（T2）、血肿清除后（T3）及手术结束时（T4）等时段组间CVP、MAP、HR差异有统计学意义；观察组GOS优良率高于对照组；组间不良反应发生率差异无统计学意义。结论：等容血液稀释联合控制性降压在颅脑外伤手术中的应用可确保脑组织血氧供应，保护脑神经，提升预后效果。

关键词 颅脑外伤 手术治疗 等容血液稀释 控制性降压技术

中图分类号：R651.15 文献标志码：A 文章编号：1006-1533（2019）19-0035-03

Effect of isovolemic hemodilution combined with controlled hypotension on neurological function in patients undergoing craniocerebral operation

GENG Jiguang， YAO Baojun， JING Hongdao

（Department of Neurosurgery， the 82nd Group Army Hospital， Hebei Baoding 071000， China）

ABSTRACT Objective： To study the effect of isovolemic hemodilution combined with controlled antihypertension on the protection of neurological function in patients with craniocerebral trauma. Methods： A total of 138 patients with craniocerebral trauma were enrolled and divided into a control group and an observation group with 69 cases each based on the digital randomization principle. The control group underwent only controlled antihypertensive treatment while the observation group was treated with isovolemic hemodilution and controlled antihypertensive therapy. The treatment efficacy and prognosis were compared between the two groups. Results： There were no significant differences between the two groups in the indicators of hemodynamic parameters and brain tissue oxygen metabolism after intubation （T0） （P>0.05）. However， there were significant differences between the two groups in CVP， MAP and HR before the controlled antihypertensive treatment （T1） ， at 30 minutes after the controlled antihypertensive treatment （T2）， after hematoma removal （T3） and the end of surgery （T4） （P<0.05）. The excellent rate of GOS was higher in the observation group than the control group （P<0.05）. There were no significant differences between the two groups in the incidence of adverse reactions （P>0.05）. Conclusion： The application of isovolemic hemodilution combined with controlled antihypertension in craniocerebral trauma surgery can ensure the blood supply to the brain tissue， protect the brain nerve and improve the prognosis.

KEy WORDS craniocerebral trauma； surgical treatment； isovolemic hemodilution； controlled hypotension

顱脑外伤患者病情十分危重，且大多伴脑挫裂伤、继发难治性颅内高压，患者运动、感觉神经受损，从而出现意识、运动以及感觉功能障碍。针对伴有颅内高压等合并症的颅脑外伤患者临床上多采用开颅血肿清除、去骨瓣减压手术治疗，手术治疗中控制性减压能够降低急性脑膨出、术后脑梗死等严重并发症[1]。急性等容血液稀释（acute normovolemic hemodilution，ANH）是在麻醉诱导前后采血的同时补充等效容量胶体液（晶体）稀释血液，减少异体血输入量的血液保护手段[2]。

1 资料与方法

1.1 一般资料

研究对象为陆军第82集团军医院2016年2月—2018年2月收治的颅脑外伤患者138例，按照数字随机原则分成两组。对……