中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
23期
1784-1787
,共4页
王其平%张世明%高恒%那汉荣%徐裕%徐军%杨磊
王其平%張世明%高恆%那漢榮%徐裕%徐軍%楊磊
왕기평%장세명%고항%나한영%서유%서군%양뢰
颅脑损伤%氧%颅内压%格拉斯哥预后评分
顱腦損傷%氧%顱內壓%格拉斯哥預後評分
로뇌손상%양%로내압%격랍사가예후평분
Traumatic brain injury%Oxygenation%Intracranial pressure%Glasgow outcome scale
目的 探讨脑组织氧分压联合颅内压监测对重型颅脑损伤治疗的指导意义,以提高脑氧为目标干预治疗的效果.方法 本文为前瞻性研究,对江阴市人民医院神经外科2009年6月至2012年6月收治46例重型颅脑损伤患者,随机分成两组,每组23例,即:应用脑组织氧分压联合颅内压监测的患者(PbtO2组)与单独进行颅内压监测的患者(ICP组),两组患者的治疗目标维持颅内压＜20 mm Hg,脑灌注压≥60 mm Hg,对脑组织氧分压监测患者,将脑组织氧分压目标控制≥20 mm Hg,伤后6个月比较两组死亡率及格拉斯哥预后评分.结果 两组平均每天的颅内压、脑灌注压水平相似的,ICP组死亡率21.7％(5例),预后良好47.8％(11例),而PbtO2组死亡率8.7％(2例),预后良好65.2％(15例),两组比较P＜0.05.结论 脑组织氧分压联合颅内压监测并依据脑组织氧分压进行指导治疗能够显著降低重型颅脑损伤患者的死亡率,改善预后.
目的 探討腦組織氧分壓聯閤顱內壓鑑測對重型顱腦損傷治療的指導意義,以提高腦氧為目標榦預治療的效果.方法 本文為前瞻性研究,對江陰市人民醫院神經外科2009年6月至2012年6月收治46例重型顱腦損傷患者,隨機分成兩組,每組23例,即:應用腦組織氧分壓聯閤顱內壓鑑測的患者(PbtO2組)與單獨進行顱內壓鑑測的患者(ICP組),兩組患者的治療目標維持顱內壓＜20 mm Hg,腦灌註壓≥60 mm Hg,對腦組織氧分壓鑑測患者,將腦組織氧分壓目標控製≥20 mm Hg,傷後6箇月比較兩組死亡率及格拉斯哥預後評分.結果 兩組平均每天的顱內壓、腦灌註壓水平相似的,ICP組死亡率21.7％(5例),預後良好47.8％(11例),而PbtO2組死亡率8.7％(2例),預後良好65.2％(15例),兩組比較P＜0.05.結論 腦組織氧分壓聯閤顱內壓鑑測併依據腦組織氧分壓進行指導治療能夠顯著降低重型顱腦損傷患者的死亡率,改善預後.
목적 탐토뇌조직양분압연합로내압감측대중형로뇌손상치료적지도의의,이제고뇌양위목표간예치료적효과.방법 본문위전첨성연구,대강음시인민의원신경외과2009년6월지2012년6월수치46례중형로뇌손상환자,수궤분성량조,매조23례,즉:응용뇌조직양분압연합로내압감측적환자(PbtO2조)여단독진행로내압감측적환자(ICP조),량조환자적치료목표유지로내압＜20 mm Hg,뇌관주압≥60 mm Hg,대뇌조직양분압감측환자,장뇌조직양분압목표공제≥20 mm Hg,상후6개월비교량조사망솔급격랍사가예후평분.결과 량조평균매천적로내압、뇌관주압수평상사적,ICP조사망솔21.7％(5례),예후량호47.8％(11례),이PbtO2조사망솔8.7％(2례),예후량호65.2％(15례),량조비교P＜0.05.결론 뇌조직양분압연합로내압감측병의거뇌조직양분압진행지도치료능구현저강저중형로뇌손상환자적사망솔,개선예후.
Objective To elucidate the effectiveness of brain tissue oxygenation (PbtO2)plus intracranial pressure (ICP) monitoring and targeted therapy in patients of severe traumatic brain injury (TBI).Methods A total of 46 patients with severe TBI(Glasgow coma scale,GCS scale ≤8)admitted at Jiangyin People's Hospital from June 2009 to June 2012 were divided randomly into 2 groups and evaluated prospectively.Patients undergoing ICP plus PbtO2 monitoring were compared with controls with ICPmonitoring alone.Therapies of both patient groups were attempted to maintain an ICP ＜ 20 mm Hg and a cerebral perfusion pressure (CPP) ≥ 60 mm Hg.Among those with PbtO2 monitoring,oxygenation was maintained at a level of ≥20 mm Hg.The scores of Glasgow outcome scale (GOS) were compared between two groups at Month 6 post-injury.Results The mean daily ICP and CPP levels were similar in each group.The mortality rate was 21.7％ in patients with ICP monitoring alone and the favorable outcome rate was 47.8％.However,those receiving combined management had a significantly reduced mortality rate of 8.7％ and good outcome rate of 65.2％ (P ＜ 0.05).Conclusion The combined use of both ICP and PbtO2may be associated with reduced mortality and improved outcome in patients with severe TBI.
