高容量血液滤过对重型颅脑损伤患者颅内压的影响

Influence of high-volume hemofiltration on intracranial pressure in patients with severe traumatic brain injury

摘要:

目的 观察重型颅脑损伤患者应用高容量血液滤过(HVHF)对其颅内压(ICP)及预后的影响.方法 选取90例GCS评分3～8分的颅脑损伤患者按照治疗方法不同分为治疗组60例与对照组30例,对照组给予常规治疗措施,治疗组在此基础上给予HVHF,连续治疗2周后评价患者ICP变化及预后.结果 治疗组3 d、7 d及14 d时颅内压均明显低于对照组(P<0.05),3 d、7 d及14 d时血清IL-6、TNF-α值均明显低于同期对照组(P<0.05),术后并发症及死亡率均明显低于对照组(P<0.05),具有统计学意义.结论 重型颅脑损伤患者术后应用HVHF治疗可显著降低颅内压增高曲线,改善患者预后.

Abstract:

Objective To evaluate the prognosis and influence of high-volume hemofiltration(HVHF) on intracranial pressure(ICP) in patients with severe traumatic brain injury.Methods A total of 90 patients with severe traumatic brain injury who had Glasgow Coma Scale scores(GCS) of 3-8 were divided into two groups according to different treatment approaches. The control group(n=30) received conventional therapy, and the treatment group(n=60) was treated with HVHF in addition to the conventional therapy. Change in ICP and prognosis were evaluated 2 weeks after the treatment.Results The ICP of patients in treatment group on days 3, 7, and 14 of treatment was significantly lower than that in control group on respective days (all P<0.05). The serum levels of interleukin-6 and tumor necrosis factor-α in treatment group on days 3, 7, and 14 of treatment were significantly lower than those in control group on respective days (all P<0.05). The incidence of postoperative complications and overall mortality in treatment group were significantly lower than those in control group (both P<0.05).Conclusions HVHF treatment markedly slows the rise of ICP and greatly improves the prognosis in patients with severe traumatic brain injury after surgery.