中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2012年
12期
1260-1262
,共3页
李钦浩%朱贵峰%张文娟%巩晓娜%周娆娆%亓雪梅%刘朋
李欽浩%硃貴峰%張文娟%鞏曉娜%週嬈嬈%亓雪梅%劉朋
리흠호%주귀봉%장문연%공효나%주요요%기설매%류붕
呼吸末二氧化碳分压%过度通气%脑外伤%脑血流%脑代谢%脑灌注
呼吸末二氧化碳分壓%過度通氣%腦外傷%腦血流%腦代謝%腦灌註
호흡말이양화탄분압%과도통기%뇌외상%뇌혈류%뇌대사%뇌관주
End tidal pressure of CO2%Hyperventilation%Traumatic brain injury%Cerebral blood flow%Brain metabolism%Cerebral perfusion
目的 探讨呼吸末二氧化碳分压(PETCO2)监测下过度通气水平对颅脑外伤患者术中脑血流、脑代谢和脑灌注的影响.方法 选择东营鸿港医院神经外科自2009年1月至2012年6月急诊行脑外伤开颅去骨瓣减压血肿清除术的患者70例,按随机数字表法分为A、B2组,每组35例,A组患者PETCO2控制在20～25 mm Hg之间,动脉血二氧化碳分压(PaCO2)维持在22～25 mm Hg之间,B组患者PETCO2控制在25～30 mm Hg之间,PaCO2维持在30～45 mm Hg之间,比较手术开始去骨瓣前2组患者血气分析结果、平均动脉压、颅内压、脑氧分压、脑灌注压和脑氧供需平衡以及代谢产物神经元特异性稀醇化酶(NSE)、葡萄糖、乳酸的变化.结果 手术开始去骨瓣前A组患者的PaCO2水平、平均动脉压、颅内压、NSE、葡萄糖和乳酸水平显著低于B组,差异有统计学意义(P＜0.05);2组患者脑氧分压和脑灌注压、动脉血氧含量(CaO2)、静脉血氧含量(CjvO2)和脑氧摄取率(CERO2)比较差异无统计学意义(P＞0.05).结论 术中将PETCO2控制在20～25 mm Hg之间,能有效维持患者脑血流灌注和脑氧供需平衡,降低病理性代谢产物水平,值得临床重视.
目的 探討呼吸末二氧化碳分壓(PETCO2)鑑測下過度通氣水平對顱腦外傷患者術中腦血流、腦代謝和腦灌註的影響.方法 選擇東營鴻港醫院神經外科自2009年1月至2012年6月急診行腦外傷開顱去骨瓣減壓血腫清除術的患者70例,按隨機數字錶法分為A、B2組,每組35例,A組患者PETCO2控製在20～25 mm Hg之間,動脈血二氧化碳分壓(PaCO2)維持在22～25 mm Hg之間,B組患者PETCO2控製在25～30 mm Hg之間,PaCO2維持在30～45 mm Hg之間,比較手術開始去骨瓣前2組患者血氣分析結果、平均動脈壓、顱內壓、腦氧分壓、腦灌註壓和腦氧供需平衡以及代謝產物神經元特異性稀醇化酶(NSE)、葡萄糖、乳痠的變化.結果 手術開始去骨瓣前A組患者的PaCO2水平、平均動脈壓、顱內壓、NSE、葡萄糖和乳痠水平顯著低于B組,差異有統計學意義(P＜0.05);2組患者腦氧分壓和腦灌註壓、動脈血氧含量(CaO2)、靜脈血氧含量(CjvO2)和腦氧攝取率(CERO2)比較差異無統計學意義(P＞0.05).結論 術中將PETCO2控製在20～25 mm Hg之間,能有效維持患者腦血流灌註和腦氧供需平衡,降低病理性代謝產物水平,值得臨床重視.
목적 탐토호흡말이양화탄분압(PETCO2)감측하과도통기수평대로뇌외상환자술중뇌혈류、뇌대사화뇌관주적영향.방법 선택동영홍항의원신경외과자2009년1월지2012년6월급진행뇌외상개로거골판감압혈종청제술적환자70례,안수궤수자표법분위A、B2조,매조35례,A조환자PETCO2공제재20～25 mm Hg지간,동맥혈이양화탄분압(PaCO2)유지재22～25 mm Hg지간,B조환자PETCO2공제재25～30 mm Hg지간,PaCO2유지재30～45 mm Hg지간,비교수술개시거골판전2조환자혈기분석결과、평균동맥압、로내압、뇌양분압、뇌관주압화뇌양공수평형이급대사산물신경원특이성희순화매(NSE)、포도당、유산적변화.결과 수술개시거골판전A조환자적PaCO2수평、평균동맥압、로내압、NSE、포도당화유산수평현저저우B조,차이유통계학의의(P＜0.05);2조환자뇌양분압화뇌관주압、동맥혈양함량(CaO2)、정맥혈양함량(CjvO2)화뇌양섭취솔(CERO2)비교차이무통계학의의(P＞0.05).결론 술중장PETCO2공제재20～25 mm Hg지간,능유효유지환자뇌혈류관주화뇌양공수평형,강저병이성대사산물수평,치득림상중시.
Objective To investigate the effect ofhyperventilation on cerebral blood flow,brain metabolism and cerebral perfusion in patients with traumatic brain injury by end tidal pressure of CO2 (PETCO2) monitoring.Methods Seventy patients with traumatic brain injury,admitted to our hospital from January 2009 to June 2012 and performed decompressive craniectomy,were chosen in our study; they were randomly divided into group A and group B (n=35); patients in the group A accepted PETCO2 within 20-25 mm Hg and arterial partial pressure of carbon dioxide (PaCO2) within 22-25 mm Hg,and patients in the group B received PETCO2 within 25-30 mm Hg and PaCO2 within 30-45 mm Hg.The blood gas pressure,mean artery pressure,cerebral oxygen partial pressure,cerebral perfusion pressure,cerebral oxygen supply and demand balance,and changes of neuron specific enolase (NSE),glucose and lactic acid were compared between the two groups at the beginning of craniectomy.Results The PaCO2 level,mean artery pressure,intracranial pressure,and levels of NSE,glucose and lactic acid in group A were significantly lower than those in group B (P＜0.05); while the brain oxygen partial pressure,cerebral perfusion pressure,arterial oxygen content (CaO2),venous oxygen content (CjvO2) and cerebral oxygen uptake rate (CERO2) showed no significant difference between the two groups (P＞0.05).Conclusion PETCO2 controlling within 20-25 mm Hg can effectively maintain the cerebral blood perfusion and cerebral oxygen supply and demand balance of the patients; it can also reduce the pathological metabolite effect on the brain tissue; therefore,its clinical value is worthy for attention.
