中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2012年
2期
141-144
,共4页
孙洪涛%程世翔%涂悦%吴焕成%李兆麟%张赛
孫洪濤%程世翔%塗悅%吳煥成%李兆麟%張賽
손홍도%정세상%도열%오환성%리조린%장새
外伤性脑损伤%亚低温%脑组织氧分压
外傷性腦損傷%亞低溫%腦組織氧分壓
외상성뇌손상%아저온%뇌조직양분압
Traumatic brain injury%Mild hypothermia%Brain tissue partial pressure of oxygen
目的 研究亚低温治疗状态下重型颅脑创伤( sTBI)患者伤后早期脑组织氧分压(PbtO2)的动态变化及临床意义.方法 38例sTBI患者进行亚低温治疗,连续监测PbtO2、颈静脉血氧饱和度(SjvO2)、颅内压(ICP)、和脑灌注压(CPP)等指标,对监测结果以及PbtO2和其他指标相关性进行分析,并记录患者伤后3个月的格拉斯哥预后评分.结果 在亚低温治疗初期,患者PbtO2、SjvO2和CPP明显上升,ICP明显下降,而治疗36 h和48 h后PbtO2及SjvO2无明显变化.亚低温治疗后ICP较治疗前明显下降,低PbtO2情况明显改善,ICP和PbtO2之间呈负相关；PbtO2及SjvO2水平明显上升,PbtO2与SjvO2呈直线正相关；PbtO2与CPP呈直线正相关.监测过程中,在SjvO2和CPP水平正常的情况下,仍有较大比例的患者出现低PbtO2情况.治疗过程中没有出现过低PbtO2水平的患者预后良好.结论 PbtO2是监测sTBI患者局部脑组织氧合的一项重要指标,具有很高敏感性,对于指导治疗和判断预后具有重要意义,而亚低温能够明显改善PbtO2降低的情况.
目的 研究亞低溫治療狀態下重型顱腦創傷( sTBI)患者傷後早期腦組織氧分壓(PbtO2)的動態變化及臨床意義.方法 38例sTBI患者進行亞低溫治療,連續鑑測PbtO2、頸靜脈血氧飽和度(SjvO2)、顱內壓(ICP)、和腦灌註壓(CPP)等指標,對鑑測結果以及PbtO2和其他指標相關性進行分析,併記錄患者傷後3箇月的格拉斯哥預後評分.結果 在亞低溫治療初期,患者PbtO2、SjvO2和CPP明顯上升,ICP明顯下降,而治療36 h和48 h後PbtO2及SjvO2無明顯變化.亞低溫治療後ICP較治療前明顯下降,低PbtO2情況明顯改善,ICP和PbtO2之間呈負相關；PbtO2及SjvO2水平明顯上升,PbtO2與SjvO2呈直線正相關；PbtO2與CPP呈直線正相關.鑑測過程中,在SjvO2和CPP水平正常的情況下,仍有較大比例的患者齣現低PbtO2情況.治療過程中沒有齣現過低PbtO2水平的患者預後良好.結論 PbtO2是鑑測sTBI患者跼部腦組織氧閤的一項重要指標,具有很高敏感性,對于指導治療和判斷預後具有重要意義,而亞低溫能夠明顯改善PbtO2降低的情況.
목적 연구아저온치료상태하중형로뇌창상( sTBI)환자상후조기뇌조직양분압(PbtO2)적동태변화급림상의의.방법 38례sTBI환자진행아저온치료,련속감측PbtO2、경정맥혈양포화도(SjvO2)、로내압(ICP)、화뇌관주압(CPP)등지표,대감측결과이급PbtO2화기타지표상관성진행분석,병기록환자상후3개월적격랍사가예후평분.결과 재아저온치료초기,환자PbtO2、SjvO2화CPP명현상승,ICP명현하강,이치료36 h화48 h후PbtO2급SjvO2무명현변화.아저온치료후ICP교치료전명현하강,저PbtO2정황명현개선,ICP화PbtO2지간정부상관；PbtO2급SjvO2수평명현상승,PbtO2여SjvO2정직선정상관；PbtO2여CPP정직선정상관.감측과정중,재SjvO2화CPP수평정상적정황하,잉유교대비례적환자출현저PbtO2정황.치료과정중몰유출현과저PbtO2수평적환자예후량호.결론 PbtO2시감측sTBI환자국부뇌조직양합적일항중요지표,구유흔고민감성,대우지도치료화판단예후구유중요의의,이아저온능구명현개선PbtO2강저적정황.
Objective To investigate clinical significant and changes of brain tissue partial pressure of oxygen (Pbt O2 ) in the course of mild hypothermia treatment (MHT) of severe traumatic brain injury (sTBI).Methods There were 38 sTBI cases with mild hypothermia treatment in the course.Pbt O2,intracranial pressure (ICP),jugularn venous oxygen saturation (SjvO2 ),and cerebral perfusion pressure (CPP) were continuously monitored for analyzing the correlations insides,and clinical outcomes were valued using the Glasgow Outcome Scale score (GOSs).Results Of 38 patients with sTBI,increasing PbtO2,Sjv O2,CPP and decreasing ICP were found obviously from the begin of MHT. There was negative linear correlation between PbtO2 and ICP.Otherwise,there was positive linear correlation between PbtO2 and SjvO2.Monitoring process which CPP and Sjv O2 levels were under normal circumstances,there were still a large proportion of patients with low PbtO2 situation after MHT.Conclusions Continuous monitoring of PbtO2 can reflect the condition of regional cerebral oxygen metabolism and guide treatment and predicting outcome.
