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目的:探讨采用早期目标导向液体复苏治疗对脑死亡后的血流动力学和氧代谢的影响。方法:对32例首次判定脑死亡的患者采用早期3h内进行目标导向液体复苏治疗,分别于首次判断为脑死亡后开始液体复苏前(T0),液体复苏后3h(T1),液体复苏后6h(T2),首次判断为脑死亡12h后(T3),通过桡动脉置管和Swan-Ganz导管获得心脏指数(CI)、平均肺动脉压(MPAP)、肺动脉楔压(PAWP)、中心静脉压(CVP)、全身血管阻力(SVR)、肺血管阻力(PVR)、氧供(DO2)、氧耗(VO2)、氧摄取率(ERO2)、动脉血乳酸(ABL)和混合静脉血氧饱和度(SvO2)。结果:与T0比较,T1～3时HR减慢(P<0.05),T1～3时MAP、CVP、PCWP、PAP、CI、SVR、PVP、DO2、VO2、SvO2升高(P<0.05或P<0.01),ERO2、ABL降低(P<0.05)。结论:脑死亡后早期出现血流动力学和氧代谢紊乱,早期目标导向液体复苏治疗可有效维持血流动力学的稳定,改善机体组织和器官的氧供需平衡。
OBJECTIVE: To investigate the effects of early target-directed fluid resuscitation on hemodynamics and oxygen metabolism after brain death. Methods: Thirty-two patients with brain death for the first time were enrolled in this study. They were treated with targeted-guided fluid resuscitation within 3 hours before the start of brain fluid resuscitation (T0), 3 h after fluid resuscitation (T1), and 6 h after fluid resuscitation ), Cardiac index (CI), mean pulmonary arterial pressure (MPAP), pulmonary arterial wedge pressure (PAWP) and central venous pressure (CVP) were measured by radial artery catheter and Swan-Ganz catheter after 12h after brain death (T3) SVR, PVR, DO2, VO2, ERO2, ABL and SvO2 were measured. Results: Compared with T0, the HR of T1 ~ 3 was slowed down (P <0.05 or P <0.05), and the MAP, CVP, PCWP, PAP, CI, SVR, PVP, <0.01), ERO2, ABL decreased (P <0.05). CONCLUSION: Hemodynamics and oxygen metabolism disorders occur early after brain death. Early target-directed fluid resuscitation can effectively maintain hemodynamic stability and improve oxygen supply and demand balance between body tissues and organs.