Prognosis Effect Of Goal-directed Fluid Therapy Combined With Methoxymine In Patients During Traumatic Brain Injury

Objective:To evaluate the effects of methoxymine introduced into goal-directed fluid therapy（GDFT）on the prognosis of patients during traumatic brain injury（TBI）.Methods:Sixty TBI patients according to the experimental requirements were divided into two groups:control group（group C）,methoxymine group（group M）,30 in each group.The ASA classification,gender,age,body mass index（BMI）and anesthesia duration of all patients were recorded.All patients underwent total intravenous anesthesia.Two groups’fluid replacement were guided by Flo Trac/Vigileo monitoring SVV.After anesthesia induction,group M was continuously pumped with methoxymine at a speed of 1.5-4μg/（kg·min）until the end of operation.The same amount of 0.9%normal saline were given in group C.MAP≥65mm Hg and SVV<13%were maintained in both groups.The experiment set Five timepoints:after anesthesia induction（T₀）,the dural mater opening（T₁）,1hour after the dural mater opening（T₂）,end of the surgery（T₃）and 12 h after surgery（T₄）.The crystal volume,colloidal volume,the volume of blood transfusion,total amount of intraoperative transfusion,urine volume,blood loss volume were recorded.Heart rate（HR）,mean arterial pressure（MAP）were recorded at each timepoint and the Jugular venous bulb oxygen saturation（SjvO₂）,the arterial to jugular bulb venous oxygen content difference（Da-jvO₂）and cerebral extraction rate of oxygen（CERO₂）were calculated according to the results of both radial artery and jugular bulb blood gas analysis.The concentrations of biochemical indicators of nerve injury including S100βprotein and neuron-specific enolase（NSE）were detected by ELISA.The glasgow coma scale（GCS）of the patients before surgery（d₀）,postoperative day1（d₁）,postoperative day3（d₃）,postoperative day5（d₅）and postoperative day7（d₇）were recorded.Glasgow outcome scale（GOS）and hospitalization time was evaluated to predict the prognosis of discharged patients.Result:1.General data comparison:there was no significant difference in gender,age,BMI,ASA classification and anesthesia duration among the two groups（P>0.05）.2.Comparison of intraoperative intake:compared with group C,the amount of crystal,colloid and total transfusion in group M were significantly reduced,（P<0.05）.There was no significant difference in erythrocyte,plasma and blood transfusion among the two groups（P>0.05）.3.Comparison of intraoperative output:compared with group C,the amount of urine was significantly lower（P<0.05）,while the urine volume of both groups were above 1 ml/（kg·h）.There was no significant difference in blood loss among the two groups（P>0.05）.4.HR comparison:there was no significant difference in heart rate among the two groups at T₀-T₄（P>0.05）.The HR of T₁-T₄ in group M were significantly lower（P<0.05）.5.MAP comparison:compared with group C,the MAP of T₁-T₃ in group M were significantly higher（P<0.05）.6.Vasoactive drug use:compared with group C,the number of patients in group M treated with methoxymine and norepinephrine was significantly reduced.7.SjvO₂ comparison:the SjvO₂ of T₁-T₄ in both two groups were higher than T₀（P<0.05）.The SjvO₂ of T₂ in group M was higher than T₁.Compared with group C,the SjvO₂ increased significantly in group M at T₁-T₄（P<0.05）.8.Da-jvO₂ comparison:compared with group C,the Da-jvO₂ of T₁-T₄ in group M were significantly decreased（P<0.05）.9.CERO₂ comparison:compared with group C,the CERO₂ of T₁-T₄ in group M were significantly decreased（P<0.05）.In group M,the CERO₂ of T₂-T₄ were significantly decreased than T₀and T₁,while CERO₂ of T₃-T₄ were significantly decreased than T₂（P<0.05）.10.jvLac comparison:compared with group C,jvLac was significantly lower at T₃ in group M（P<0.05）.11.The comparison of S100βprotein:compared with group C,the S100βprotein of T₄ in group M was significantly decresed（P<0.05）.12.NSE comparison:compared with group C,the NSE of T₄ in group M were significantly lower（P<0.05）.13.Comparison of GCS scores:compared with group C,the GCS of d₃,d₅,d₇ in group M were significantly higher（P<0.05）.14.Comparison of GOS score and hospitalization time:there was no significant difference in GOS score and hospitalization time among the two groups（P>0.05）.Conclusion:GDFT combined with methoxamine during operation can optimize infusion scheme,stabilize hemodynamics,protect the central nervous system and improve the prognosis of TBI patients better.