中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2001年
1期
38-40
,共3页
只达石%张赛%林欣%陈荷红%肖绪林%苏晨方%尚彦国%牛玉德%刘敬业%张楷文%毛瑞%曹海华%杨谨涛%马宁
隻達石%張賽%林訢%陳荷紅%肖緒林%囌晨方%尚彥國%牛玉德%劉敬業%張楷文%毛瑞%曹海華%楊謹濤%馬寧
지체석%장새%림흔%진하홍%초서림%소신방%상언국%우옥덕%류경업%장해문%모서%조해화%양근도%마저
脑损伤%重型%亚低温%脑组织氧分压%脑温
腦損傷%重型%亞低溫%腦組織氧分壓%腦溫
뇌손상%중형%아저온%뇌조직양분압%뇌온
目的 研究重型脑损伤急性期脑组织氧分压(PbtO2)和脑温(BT)的变化及亚低温治疗对PbtO2和BT变化的影响。方法 重型脑损伤病人18例,在伤后1～20小时内行亚低温治疗,直肠温度(RT)控制在31．5℃～34．9℃,持续1～7天,平均57．7±28．4小时。同时监测病人的PbtO2和BT等指标。PbtO2和BT监测使用LICOX-Ⅱ型(德国)PbtO2和BT代谢仪,分别用PbtO2和BT探头置于无明显损伤的额叶白质内(硬膜下27～36mm深处),持续监测1～5天,平均54．8±27．0小时。伤后3个月时根据GOS评估法判定预后。结果 本组18例病人脑损伤后24小时内PbtO2值(9．6±6．8mmHg)均明显低于正常值水平(16～40mmHg)。亚低温治疗24小时后PbtO2显著提高到28．7±8．8mmI6,伤后第3天时仍稳定在正常值范围内。重型脑损伤急性期BT高于RT,亚低温治疗使BT与RT差距增大。过度换气(PaCO2=25mm-Hg左右)可降低脑损伤后的高颅压,但同时导致PbtO2明显下降。结论在重型颅脑损伤急性期应用PbtO2和BT直接监测技术,安全可靠,对于判定病情以及指导亚低温和过度换气等治疗措施,具有重要意义。
目的 研究重型腦損傷急性期腦組織氧分壓(PbtO2)和腦溫(BT)的變化及亞低溫治療對PbtO2和BT變化的影響。方法 重型腦損傷病人18例,在傷後1～20小時內行亞低溫治療,直腸溫度(RT)控製在31．5℃～34．9℃,持續1～7天,平均57．7±28．4小時。同時鑑測病人的PbtO2和BT等指標。PbtO2和BT鑑測使用LICOX-Ⅱ型(德國)PbtO2和BT代謝儀,分彆用PbtO2和BT探頭置于無明顯損傷的額葉白質內(硬膜下27～36mm深處),持續鑑測1～5天,平均54．8±27．0小時。傷後3箇月時根據GOS評估法判定預後。結果 本組18例病人腦損傷後24小時內PbtO2值(9．6±6．8mmHg)均明顯低于正常值水平(16～40mmHg)。亞低溫治療24小時後PbtO2顯著提高到28．7±8．8mmI6,傷後第3天時仍穩定在正常值範圍內。重型腦損傷急性期BT高于RT,亞低溫治療使BT與RT差距增大。過度換氣(PaCO2=25mm-Hg左右)可降低腦損傷後的高顱壓,但同時導緻PbtO2明顯下降。結論在重型顱腦損傷急性期應用PbtO2和BT直接鑑測技術,安全可靠,對于判定病情以及指導亞低溫和過度換氣等治療措施,具有重要意義。
목적 연구중형뇌손상급성기뇌조직양분압(PbtO2)화뇌온(BT)적변화급아저온치료대PbtO2화BT변화적영향。방법 중형뇌손상병인18례,재상후1～20소시내행아저온치료,직장온도(RT)공제재31．5℃～34．9℃,지속1～7천,평균57．7±28．4소시。동시감측병인적PbtO2화BT등지표。PbtO2화BT감측사용LICOX-Ⅱ형(덕국)PbtO2화BT대사의,분별용PbtO2화BT탐두치우무명현손상적액협백질내(경막하27～36mm심처),지속감측1～5천,평균54．8±27．0소시。상후3개월시근거GOS평고법판정예후。결과 본조18례병인뇌손상후24소시내PbtO2치(9．6±6．8mmHg)균명현저우정상치수평(16～40mmHg)。아저온치료24소시후PbtO2현저제고도28．7±8．8mmI6,상후제3천시잉은정재정상치범위내。중형뇌손상급성기BT고우RT,아저온치료사BT여RT차거증대。과도환기(PaCO2=25mm-Hg좌우)가강저뇌손상후적고로압,단동시도치PbtO2명현하강。결론재중형로뇌손상급성기응용PbtO2화BT직접감측기술,안전가고,대우판정병정이급지도아저온화과도환기등치료조시,구유중요의의。
Objective To study the changes of partial pressure of braain tissue oxygen (PbtO2) and brain temperature (BT) in acute phase of patients with severe bead injury, and effect of mild hypothermie on PbtO2 and BT. Methods PbtO2 and BT of 18 patients with severe head injury were monitored, and hypothermia was induced within 20 hours of injury. Rewarming was begun on 1-7 days ( average 57.7 ± 28.4 hours) after the rectal temperature (BT)reached 31.5℃-34.9℃. Monitoringe of PbtO2 and BT were lasted for 1-5 days (average 54.8 ± 27.0 hours). According to Glasgow Outcome Scale(GOS),the prognosis of the patients was evaluated.Results Within 24 hours after severe head injury, PbtO2 was significantly lower (9.6 ± 6.8mmHg) than the normal value (16-40mmHg). BT was higher than RT. After treatment in mild hypothermia, eman PbtO2 raised to 28.7±8.8 mmHg during the first 24hours, and the PbtO2 1evel was maintained within the range of normal value at the third day after injury. The difference between BT and RT significarntly appeared in mild hypothemia. Hyperventilation (PaCO2≈25mmHg) induced and sensitive diagnostic method for the patients with severe head injury. It might become an important tool in our treatment regime for acute patients of severe head injury during hypothermia and hyperventilation.
