颈静脉血氧饱和度对重型颅脑损伤患者的预后评估

目的探讨颈静脉血氧饱和度对重型颅脑损伤患者的预后评估。方法选择我科收治的23例重型颅脑损伤患者,进行颈内静脉导管采血,同时穿刺桡动脉留置导管监测动脉血氧饱和度(SaO2),并计算动-静脉血氧饱和度差(SajO2),每6-8h或颅脑体征发生较大变化时分别采血送检;并特别采集急性脑损伤后24h血样。通过颈内静脉血气和桡动脉血气,计算颈内静脉氧饱和度(SjvO2)、脑氧摄取(CEO2)和动静脉氧含量差(AVDO2)。为观察SjvO2与预后的关系,将病例分为死亡组和存活组,观察期限为病人死亡或出院为止。结果死亡组与存活组SjvO2、CEO2、AVDO2变化:除伤后1 d以外,伤后2-5 d死亡组和存活组的SjvO2、CEO2和AVDO2间差异均有统计学意义(P均<0.05)。结论颈静脉氧饱和度的监测结合CEO2、AVDO2的变化分析,可以间接反映重型颅脑损伤患者脑组织血流及氧代谢功能情况,反映病情,评估预后。

Evaluating prognosis of patients with severe head injury through oxygen saturation of juglar vein (SjvO2)

Objective To explore the role of SjvO2 in evaluating Prognosis of patients with Severe Head Injury. Methods Twenty-three patients with severe head injury were selected in our department. Their blood were sapmled through catheters in internal carotid veins. And SaO2 were monitored through cathethers in radius arteries. SajO2 was caculated. The vein blood samples were obtained and investigated every 6-8 hours or while remarkable changs in neurological signs happened, especially at 24th hour after injury through blood-gas analysis in internal carotid veins and radius arteries, SjvO2, cerebral extraction of oxygen (CEO2) and cerebral arteriovenous difference of oxygen (AVDO2) were caculated respectively. In order to clearify the relationship between the prognosis and SjvO2, the patients were divided into survival and death groups. They were observed until they died or discharged. Results The changes in SjvO2, CEO2 and AVDO2 of survival or death groups: Except the 1 st day after injury, there were significant differences in SjvO2 ,CEO2 and AVDO2 between survial and death groups from the 2nd to 5th day after injury(all P <0. 05). Conclusions It can indirectly reflect cerebral blood fluid , oxygen metabolic function and clinical conditions and can evaluate the prognosis in patients with severe head injury by monitoring SjvO2 in internal carotid veins and analyzing the changes in CEO,, AVDO2.