重型颅脑损伤后局部脑氧饱和度的监测及意义

目的探讨重型颅脑损伤后局部脑氧饱和度(rScO2)的变化规律及意义。方法选择29例重型颅脑损伤病人为研究对象,采用近红外线光谱仪(NIRS)持续监测rScO2,与脉搏血氧饱和度(SpO2)、动脉血氧饱和度(SaO2)、平均动脉压(MAP)、颅内压(ICP)和脑灌注压(CPP)等,并将监测结果进行分析比较。结果重型颅脑损伤后rScO2均明显降低。23例存活病人术后早期rScO2呈不同程度上升,此后随ICP变化呈普遍下降然后又逐步上升的趋势。另6例rScO2呈持续性降低者均死亡。SpO2、SaO2、MAP除在死亡病例临死前进行性降低外,整个监测过程中均正常。结论NIRS持续监测rScO2能准确反映重型颅脑损伤后脑氧代谢的变化规律,对临床治疗及预后评估也有重要价值。

Monitoring and clinical significance of regional cerebral oxygen saturation after severe brain trauma

Objective To investigate the changes and significance of regional cerebral oxygen saturation (rScO2) after severe brain trauma. Methods Twenty-nine comatose patients admitted to our hospital after severe brain trauma were given continuously monitoring of regional cerebral oxygen saturation (rScO2) by near-infrared spectroscopy (NIRS). Arterial oxygen saturation (SaO2), pulse oxygen saturation (SpO2), mean arterial blood pressure (MAP), intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were monitored at the same time. Results rScO2 reduced dramatically in all patients after brain trauma. In 23 survivals, rScO2 went up shortly after operations, then declined for various duration,at last it restored gradually with the normalization of ICP.In 6 dead cases, rScO2 reduced continuously; however, SpO2?SaO2?MAP showed no significant change before patients died. Conclusions rScO2 can reflect cerebral oxygen metabolism accurately after severe brain trauma. rScO2 montoring is valuable in judging prognosis and guiding treatment.