CAJ | 학술논문

目的探讨上腔静脉-颈内静脉血氧饱和度差值(ScVO2-SjVO2)与重型颅脑损伤患者脑损伤程度和预后的关系及其临床价值.方法选择重型颅脑损伤患者43例,按照入院时格拉斯哥昏迷量表(GCS)评分分为GCS评分3～5分组19例;GCS评分6～8分组24例;选取同期非颅脑损伤,意识清醒的患者20例作为对照组.观察各组患者入ICU后0,12,24,48 h时ScVO2-SjVO2的变化.并根据患者入ICU时ScVO2-SjVO2大小,分为ScVO2-SjVO2＜ 0.05组12例;ScVO2-SjVO20.05 ～0.15组14例;ScVO2-SjVO2＞ 0.15组17例,观察各组间患者GCS评分及28 d时病死率情况.结果 GCS评分3～5分组入ICU后0,12,24,48 h时ScVO2-SjVO2均较对照组明显减小(-0.071±0.032比0.093±0.049,-0.097±0.052比0.081±0.052,-0.035±0.031比0.089±0.059,0.036±0.033比0.081±0.064),差异有统计学意义(P＜0.01);GCS评分6～8分组入ICU后0,12,24h时ScVO2-SjVO2分别为0.173±0.043,0.158±0.067,0.123±0.073,均较对照组明显升高,差异有统计学意义(P＜ 0.01或＜0.05).ScVO2-SjVO2＜ 0.05组及ScVO2-SjVO2＞ 0.15组病死率均较ScVO2-SjVO2 0.05～0.15组明显增加(8/12,4/17比1/14),差异有统计学意义(P＜0.01).ScVO2-SjVO2＜ 0.05组和ScVO2-SjVO2＞ 0.15组GCS评分均低于ScVO2-SjVO2 0.05 ～ 0.15组[(4.17±1.34)、(5.88±1.35)分比(6.86±1.35)分],差异有统计学意义(P＜ 0.01或＜0.05).结论 ScVO2-SjVO2＜ 0.05时,差值大小与脑损伤程度呈负相关;ScVO2-SjVO2＞0.15时,差值大小与脑损伤程度呈正相关.ScVO2-SjVO2可反映患者的脑氧代谢情况,能客观及时地评估脑损伤程度,为重型颅脑损伤的治疗提供循证依据,同时能早期预测患者的预后.
목적 탐토상강정맥-경내정맥혈양포화도차치(ScVO2-SjVO2)여중형로뇌손상환자뇌손상정도화예후적관계급기림상개치.방법 선택중형로뇌손상환자43례,안조입원시격랍사가혼미량표(GCS)평분분위GCS평분3～5분조19례;GCS평분6～8분조24례;선취동기비로뇌손상,의식청성적환자20례작위대조조.관찰각조환자입ICU후0,12,24,48 h시ScVO2-SjVO2적변화.병근거환자입ICU시ScVO2-SjVO2대소,분위ScVO2-SjVO2＜ 0.05조12례;ScVO2-SjVO20.05 ～0.15조14례;ScVO2-SjVO2＞ 0.15조17례,관찰각조간환자GCS평분급28 d시병사솔정황.결과 GCS평분3～5분조입ICU후0,12,24,48 h시ScVO2-SjVO2균교대조조명현감소(-0.071±0.032비0.093±0.049,-0.097±0.052비0.081±0.052,-0.035±0.031비0.089±0.059,0.036±0.033비0.081±0.064),차이유통계학의의(P＜0.01);GCS평분6～8분조입ICU후0,12,24h시ScVO2-SjVO2분별위0.173±0.043,0.158±0.067,0.123±0.073,균교대조조명현승고,차이유통계학의의(P＜ 0.01혹＜0.05).ScVO2-SjVO2＜ 0.05조급ScVO2-SjVO2＞ 0.15조병사솔균교ScVO2-SjVO2 0.05～0.15조명현증가(8/12,4/17비1/14),차이유통계학의의(P＜0.01).ScVO2-SjVO2＜ 0.05조화ScVO2-SjVO2＞ 0.15조GCS평분균저우ScVO2-SjVO2 0.05 ～ 0.15조[(4.17±1.34)、(5.88±1.35)분비(6.86±1.35)분],차이유통계학의의(P＜ 0.01혹＜0.05).결론 ScVO2-SjVO2＜ 0.05시,차치대소여뇌손상정도정부상관;ScVO2-SjVO2＞0.15시,차치대소여뇌손상정도정정상관.ScVO2-SjVO2가반영환자적뇌양대사정황,능객관급시지평고뇌손상정도,위중형로뇌손상적치료제공순증의거,동시능조기예측환자적예후.
Objective To explore the relationship between superior vena cava-jugular vein oxygen saturation-differential value (ScVO2-SjVO2) and injury severity and prognosis in patients suffered from severe traumatic brain injury,finding out the chnical value.Methods Forty-three patients with severe tranmatic brain injury were selected and divided into two groups according to Glasgow Coma Scale (GCS) score,19 cases were enrolled in GCS 3-5 scores group;24 cases in GCS 6-8 scores group;20 contemporaneous cases in control group had conscious and without traumatic brain injury.The changes of ScVO2-SjVO2 at 0,12,24,48 h after admission of ICU among the groups were observed.In addition according to the degree of change in ScVO2-SjVO2,12 cases were enrolled in ScVO2-SjVO2 ＜ 0.05 group;14 cases in ScVO2-SjVO2 0.05-0.15 group; 17 cases in ScVO2-SjVO2 ＞ 0.15 group.The GCS score and mortality rate in patients after brain injury 28 d among groups were observed.Results GCS 3-5 scores group compared with control group,ScVO2-SjVO2 reduced significantly at 0,12,24,48 h after admission of ICU (-0.071 ±0.032 vs.0.093 ±0.049,-0.097 ±0.052 vs.0.081 ±0.052,-0.035 ±0.031 vs.0.089 ± 0.059,0.036 ± 0.033 vs.0.081 ± 0.064),there were significant differences (P ＜ 0.01).GCS 6-8 scores group compared with control group,ScVO2-SjVO2 dramatically increased at 0,12,24 h after admission of ICU(0.173 ± 0.043,0.158 ± 0.067,0.123 ± 0.073),there were significant differences (P ＜ 0.01 or ＜ 0.05).ScVO2-SjVO2 ＜0.05 group and ScVO2-SjVO2 ＞0.15 group compared with ScVO2-SjVO2 0.05-0.15group,the mortality rate significantly increased,the mortality rate were 8/12,4/17,1/14,respectively,there were significant differences (P ＜0.01).ScVO2-SjVO2 ＜0.05 group and ScVO2-SjVO2 ＞0.15 group compared with ScVO2-SjVO2 0.05-0.15 group,GCS score decreased significantly[(4.17 ± 1.34),(5.88 ±1.35) scores vs.(6.86 ± 1.35) scores],and there was significant difference (P ＜0.01 or ＜0.05).Conclusions When ScVO2-SjVO2 ＜ 0.05,the difference is negatively related to the deg~e of brain injury.When ScVO2-SjVO2 ＞0.15,the difference is positively related to the degree of brain injury;ScVO2-SjVO2 can assess injury severity objectively in patients who suffered from severe traumatic brain injury,and it also expresses the rate of cerebral oxygen metabolism.It can provide a basis for treatment accurately and timely,and judgment prognosis.