Stroke Volume Variation Combned With Cerebral Perfusion Pressure Target Guilded Perioperation Fruild Management In Brain Injury Patients

Background:The survival rate after brain injury is dependent on the control of cerebral perfusion pressure（CPP）and the provision of systemic hemodynamic support.However the effect of monitoring CPP for several brain injury patients study has been proved.In this study we hypothesized that meticulous fluid management using stroke volume variation（SVV）and CPP dual monitoring is feasible to sustain optimal perioperative cerebral perfusion and minimize the postoperative complication of brain injury patients.Metrods:72 brain injury patients,whose Glasgow Coma Scale（GCS）are below 8 underwent depressive craniectomy in our hospital,were randomly assigned to Group A,control group that received the routine fluid management keeping CVP 5¹2mmHg,MAP 60⁹0mmHg,HR 60¹20bpm during the perioperative period.group B,protocol group that,received SVV monitor to guide fluid management（SVV<13）,in addition,received CPP monitor and sustained CPP between 50mmHg and 70mmHg to maintain optimal cerebral perfusion postoperatively.The serum neuron-specific enolase（NSE）levels,SjVO₂、cerebral extraction of oxygen（CEO₂）,arteriovenous oxygen difference（AVDO₂）,venous-arterial PCO₂ difference（VAPCO₂）,arteriovenous difference of lactate（AVDL）were assessed at postoperative 1st、3th、5th、and 7th day respectively.Furthermore the postoperative complications and all cause mortality within 28 postoperative days were compared between two groups.Results:seventy two brain injury patients initially evolved the study.Ten patients had been excluded（Group A four patients,Group B six patients）,because of family abandonment of treatment,or uncontrolled intracranial hypertension（ICP>25mmHg）.Postoperative Serum NSE of the patients in Group B was less lower than in the control group with statistically significant differences（P<0.05）,and at fist day after operation serum NSE was not obvious difference between the two groups patients（P>0.05）.At the third day、fifth day and seventh day after operation,it was less lower in the control group significantly（P<0.05）.Statistically significant differences were revealed for the values of SjVO₂、CEO₂、AVDO₂、VAPCO₂、AVDL between Group A and Group B.The value of SjVO₂ was higher and the value of CEO₂、AVDO₂、VAPCO₂、AVDL were lower in the control group with statistically significant differences（P<0.05）.Except the value of SjVO₂、AVDL at the first day postoperatively,all these values are significantly differences at the postoperative third day、fifth day、seventh day between the two groups（P<0.05）.the incidence of heart dysfunction、pulmonary infection、cerebral infarction and secondary cerebral hemorrhage was higher in the Group A with statistically significant differences（P<0.05）.the incidence of the rest complications（hemorrhage of upper gastrointestinal tract、diabetes insipidus、tramatic epilepsy、intracranial infection、cerebrospinal fluid leakage、hernia）was less significantly differences（P>0.05）.the good recovery rate of the patients was significant higher in Group B according to GOS.The mortality of postoperative twenty eight days had no significant difference between Group A and Group B（P>0.05）.Conclusion:The method that SVV combined with CPP targetly guilded perioperative fluid management of brain injury patients could feasible to maintain adequate cerebral perfusion and reduce fluid therapy related complications.But all cause mortality rate of two groups was not significantly different.