脑氧饱和度监测在重症动脉瘤性蛛网膜下腔出血术后管理的应用研究

目的分析以局部脑氧饱和度(rScO 2)监测为目标导向的重症动脉瘤性蛛网膜下腔出血(SaSAH)术后神经重症集束化管理的应用价值。方法该研究为单盲随机对照试验。前瞻性连续纳入2017年6月至2019年6月河南省人民医院神经外科重症监护室(ICU)收治的符合纳排标准的SaSAH手术治疗患者,采用随机数字表法进行随机分组,对照组实施常规的神经重症监护治疗,试验组在此基础上实施以rScO 2为目标导向的神经重症集束化管理干预,包括神经系统专科监测、血流动力学管理、体温管控、癫痫的预防与控制等。比较两组患者的基本临床资料以及术后随访90 d时主要有效性评价指标改良Rankin量表(mRS)、细化型格拉斯哥预后量表(GOS-E)]、次要有效性评价指标(ICU住院时间)及安全性评价指标迟发性脑缺血(DCI)、颅内感染、脑积水、死亡]的差异。结果共209例SaSAH手术治疗的患者符合纳入标准并纳入入组。试验组104例,其中98例获得临床随访,失访6例;对照组105例,其中98例获得临床随访,失访7例。两组研究对象基本临床资料差异均无统计学意义(均P>0.05);试验组ICU住院时间和并发症如DCI、脑积水发生率均低于对照组,差异均有统计学意义分别为(12±6)d比(15±8)d,3.1%(3/98)比10.2%(10/98)、4.1%(4/98)比12.2%(12/98);t=-2.775,χ^2值分别为4.037、4.356,P值分别为0.006、0.045、0.037];试验组在随访90 d时的mRS评分及GOS-E评分均优于对照组(3.6±0.9)分比(4.1±0.8)分,(6.2±1.8)分比(5.5±2.5)分],差异均有统计学意义(P值分别为<0.01、0.015)。结论以rScO2监测为目标导向的SaSAH术后神经重症集束化管理,能有效缩短患者的住院周期,改善临床治疗的有效性及安全性。

Application of cerebral oxygen saturation monitoring on postoperative management of severe aneurysmal subarachnoid hemorrhage

Objective To assess the application value of regional cerebral oxygen saturation(rScO 2)monitoring on postoperative management of the severe aneurysmal subarachnoid hemorrhage(SaSAH).Methods A prospective,single-blind,randomized controlled trial was performed in the Neurosurgery Intensive Care Unit(ICU)of Henan People′s Hospital from June 2017 to June 2019.All 196 patients with SaSAH who underwent surgeries were continuously enrolled and randomly divided into two groups using the method of random number table.The control group was treated with routine neurological intensive care,while the experimental group additionally accepted rScO 2 oriented neurological intensive management such as Nervous system specialist monitoring,hemodynamic management,temperature control,prevention and control of epilepsy.These difference of Clinical baseline data,the primary assessment index of effacicy at 90 days postoperative follow-up including modified Rankin Scale(mRS)and refined Glasgow prognostic scale(GOS-E),the secondary assessment index at 90 days postoperative follow-up including the length of stay in ICU,and the safety index at 90 days postoperative follow-up including delayed cerebral ischemia(DCI),intracranial infection,hydrocephalus and death,were compared between the two groups.Results All 209 eligible patients with SaSAH who underwent surgeries were enrolled.There were 104 patients in the experimental group and 105 patients in the control group.In the experimental group,98 patients had a clinical follow-up,and 6 patients had a loss of follow-up.In the control group,98 pat ients had a clinical follow-up,and 6 patients had a loss of follow-up.There was no significant difference in clinical baseline data between the two groups(P>0.05).The length of stay in the ICU and complication incidences such as DCI and hydrocephalus,were lower in the experimental group compared to the control group(12±6 vs.15±8 d,P=0.006;3.1%3/98]vs.10.2%10/98],P=0.045;4.1%4/98]vs.12.2%12/98],P=0.037,respectively).The experimental group had better mRS score and GOS-E score at the 90-day follow-up than the control group(3.6±0.9 vs.4.1±0.8,P<0.01;6.2±1.8 vs.5.5±2.5,P=0.015,respectively).Conclusion rScO 2 monitoring oriented postoperative intensive management for patients with SaSAH can effectively shorten the hospitalization stay and improve clinical outcomes and the prognosis.