Effects Of Goal-directed Fluid Therapy Combined With Low Dose Norepinephrine In Patients During Traumatic Brain Injury

Objective:To explore the effects of goal-directed fluid therapy（GDFT）with stroke volume variation（SVV）as the target combined with continuous infusion of low-dose norepinephrine on patients during traumatic brain injury（TBI）.Method:Eighty TBI patients according to the experimental requirements were selected.Divided them into four groups:control group（group C）,GDFT group（group G）,low dose norepinephrine group（group N）and GDFT combined low dose norepinephrine group（group GN）.All patients underwent total intravenous anesthesia.During the operation,group N received low-dose norepinephrine(0.01⁰.03μg·kg-1·min^-1)with introperative fluid transfusion according to classical fluidmanagement strategies,group G received the same amount of saline with GDFT,group GN received GDFT combineed with low-dose norepinephrine,group C received introperative fluid transfusion according to classical fluidmanagement strategies with the same amount of saline.Seted five timepoints during the operation:after anesthesia induction（T₀）,the dural mater opening（T₁）,1hour after the dural mater opening（T₂）,end of surgery（T₃）and 12 h after surgery（T₄）.Jugular bulb lactate and hemodynamic parameters such as HR,MAP were recorded at each timepoint.The SjvO₂,Da-jvO₂ and CERO₂ were calculated according to the results of both radial artery and jugular bulb blood gas analysis.Jugular bulb blood was collected to measure serum S100βand NSE at each timepoint.The urine volume,blood loss volume,crystal volume,colloidal volume and total infusion volume of patients during surgery were recorded.The GCS of the patients before surgery（d₀）,postoperative day₁（d₁）,postoperative day₃（d₃）,postoperative day₅（d₅）and postoperative day7（d₇）were recorded.GOS was evaluated to predict the prognosis of discharged patients.Results:1.There was no significant difference in patients’age,gender,IBM（kg/m²）,ASA classification and anesthesia duration（min）,（P>0.05）.2.Compared with group C,the amount of crystal,colloid and total infusion in group N,group G and group GN were significantly lower,（P>0.05）.Compared with group N,the amount of crystal and total infusion in group GN were significantly lower,（P<0.05）.3.Compared with group C,the number of patients treated with ephedrine or norepinephrinein in group G,group N and group GN were significantly less.4.Compared with group C,the HR of T₁ in group N,the HR of T₁ and T₃ in group G and the HR of T₁-T₄ in group GN were significantly lower,（P<0.05）.Compared with group N and group G,the HR of T₂-T₄ in group GN were significantly lower,（P<0.05）.5.Compared with group C,the MAP of T₁ and T₂ in group G and group N,the MAP of T₁,T₂ and T₃ in group GN were significantly higher,（P<0.05）.Compared with group G,the MAP of T₁ in group N were significantly higher,（P<0.05）.6.Lactic acid value in the bulb of internal jugular vein:compared with group C,the value of T₂ and T₄ in group GN significantly decreased,（P<0.05）.7.Compared with group C,the SjvO₂ of T₂-T₄ in group G and it of T₁-T₄in group N and GN group were significantly higher,（P<0.05）.Compared with group G and group N,the SjvO₂ of T₁-T₃ in group GN were significantly higher,（P<0.05）.8.Compared with group C,the Da-jvO₂ of T₁-T₄ in group G and group GN were significantly lower,it of T₁,T₃ and T₄ in group N were significantly lower,（P<0.05）.Compared with group N,the Da-jvO₂ of T₁,T₂ and T₄ in group GN,the Da-jvO₂ of T₄ in group G were significantly lower,（P<0.05）.Compared with group G,the Da-jvO₂ of T₂ in group GN were significantly lower,（P<0.05）.9.Compared with group C,the CERO₂ of T₁-T₄ in group G,group GN and group N were significantly lower,（P<0.05）.Compared with group N,the CERO₂ of T₁-T₄ in group GN were significantly lower,（P<0.05）.Compared with group G,the CERO₂ of T₁-T₃ in group GN were significantly lower,（P<0.05）.10.Compared with group C,the S100βprotein concentration of T₂-T₄ in group G and group N and it of T₁-T₄ in group GN were significantly lower,（P<0.05）.11.Compared with group C,the NSE concentration of T₂-T₄ in group N and group GN were significantly lower,（P<0.05）.Compared with group C,the NSE concentration of T₃-T₄ in group G were significantly lower,（P<0.05）.12.Compared with group C,the GCS of d₃ in group G and group N were significantly higher,（P<0.05）.Compared with group C,the GCS of d₁,d₃,d₅,d₇ in group GN were significantly higher,（P<0.05）.Compared with group G and group N,the GCS of d₃,d₅,d₇ in group GN were significantly higher,（P<0.05）.13.Prognosis:there was no statistically significant difference in GOS before discharge and postoperative hospitalization days（P>0.05）.Conclusion:GDFT combined with low-dose norepinephrine during operation can protect the central nervous system and improve the prognosis of TBI patients better.