Neuroprotective Effects Of Goal-directed Fluid Therapy Combineed With Dexmedetomidine On Patients During Traumatic Brain Injury

Objective:To evaluate the brain protective effects of goal-directed therapy combined with dexmedetomidine on patients with traumatic brain injury.Methods:We included 80 patients with traumatic brain injury.They were randomly divided into four groups（n=20）:group C（control group）,group G（goal-directed fluid therapy group）,group D（dexmedetomidine group）and group GD（goal-directed fluid therapy with dexmedetomidine group）.For group D and group GD,prior to induction of anesthesia dexmedetomidine（iv.）were pumped into patients by 1μg/kg for 10 min,then 0.5μg/（kg·h）continuously to the end of the surgery.And the Group C and Group G were given the same amount of saline.Patients in group C and group D received introperative fluid transfusion according to classical fluidmanagement strategies.For group G and group GD,fluid infusion was done based the SVV on the FloTrac/Vigileo monitor.Artery blood and internal jugular vein bulb blood were collected for blood gas analysis at the timepoints:after anesthesia induction（T₀）,the dural mater opening（T₁）,the dural mater suturing（T₂）,end of surgery（T₃）and 12 h after surgery（T₄）.The arterial oxygen saturation（Sa O₂）,jugular bulb oxygen saturation（SjvO₂）,arterial oxygen partial pressure（PaO₂）,jugular bulb oxygen partial pressure（PjvO₂）,jugular bulb lactate were recorded to calculate the cerebral artery and internal jugular vein bulb oxygen content difference（Da-jvO₂）and the cerebral oxygen uptake rate（CERO）.As well,the serum concentrations of S100βprotein was tested.The GOS score,fluid intake and output,and postoperative hospital days of the four groups 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.Results:1.Compared with group C,the HR of T₁^T₄ in group D and group GD were significantly lower（P<0.05）.Compared with group G,the HR of T₂^T₄in group D and group GD were significantly lower（P<0.05）.Compared with group G and group D and group GD,the MAP of T₁ in group C were significantly lower（P<0.05）.2.Compared with group C,the SjvO₂ of T₁^T₄ in group GD were significantly higher（P<0.05）,the CERO of T₁^T₄ in group GD were significantly lower（P<0.05）,the S100βof T₂^T₄ in group GD were significantly higher than T₀（P<0.05）.Compared with group G and group D,the Sjv O₂ of T₁^T₃ in group GD were significantly higher（P<0.05）,the CERO of T₁^T₃ in group GD were significantly lower（P<0.05）,the S100βof T₂^T₄ in group GD were significantly lower（P<0.05）.3.Compared with group C,the Da-jvO2 of T₂^T₄ in group GD were significantly lower（P<0.05）.Compared with group G,the Da-jvO₂ of T₃ in group GD were significantly lower（P<0.05）.4.Compared with group C,group G and group D,the GCS of d₃ in group GD were significantly higher（P<0.05）.5.Compared with group C and group D,the Crystalloid,Colloid,Total volume in group G and group GD were significantly declined（P<0.05）.Conclusion:In patients with traumatic brain injury receiving goal-directed fluid therapy and infusing dexmedetomidine continuously during surgical anesthesia can provide a better protective effect on brain.