重型颅脑损伤后脑氧代谢相关参数的变化及临床意义

目的探讨重型颅脑损伤后脑氧代谢相关参数的变化及临床意义。方法重型颅脑损伤患者32例,按预后分良好组和不良组,通过颈内静脉置管和股动脉穿刺同时采样,观察颈静脉血氧饱和度(SjO2)、脑氧摄取(CEO2)、脑动静脉氧差(AJDO2)、标化的CEO2(40CEO2)和标化的AJDO2(34AJDO2)的动态变化,并分析与预后的关系。结果颅脑损伤后早期SjO2下降,40CEO23、4AJDO2上升,之后呈反方向变化趋势;预后良好组和不良组间,脑缺血(SjO2<55%、40CEO2>40%、AJDO2/34AJDO2>7.5 m l/d l)的频数差异有统计学意义,而脑充血(SjO2>75%、40CEO2<24%、AJDO2/34AJDO2<1.3 m l/d l)的频数差异无统计学意义。结论颅脑损伤后早期存在缺血而后充血的过程,反映脑缺血倾向的脑氧代谢参数与预后相关,反映脑充血倾向的参数与预后无关。

Changes and significance of related parameters on cerebral oxygen metabolism in patients with severe brain injury

Objective To investigate the changes and significance of related parameters on cerebral oxygen metabolism in patients with severe brain injury.Methods Thirty-two patients with acute severe brain injury were involved in the study and divided into good outcome group and bad outcome group according to Glasgow Outcome Scale.The dynamic changes of oxygen saturation of jugular blood(SjO_2),cerebral extraction of oxygen(CEO_2),cerebral arteriovenous difference of oxygen(AJDO_2),standardized CEO_2(~(40)CEO_2) and standardized AJDO_2(~(34)AJDO_2) were observed by using the technique of jugular catheterization,femoral artery puncture and blood sampling simultaneously,and the relationship between the parameters was analyzed.Results The SjO_2 was deceased,and the ~(40)CEO_2 and ~(34)AJDO_2 was increased in the early period.The indexes changed in the opposite direction lately.The rate of cerebral ischemia(SjO_2<55%,~(40)CEO_2>40%,AJDO_2/~(34)AJDO_2>7.5ml/dl) was significantly different between the good outcome group and bad outcome group,but the rate of cerebral hyperemia(SjO_2>75%,~(40)CEO_2<24%,AJDO_2/~(34)AJDO_2<1.3ml/dl) was not significantly different between the two groups.Conclusion There is a process of cerebral ischemia and then hyperemia in the early period after brain injury.Parameters that reflect cerebral ischemia are correlated with the prognosis,and those of the cerebral hyperemia are not correlated with the prognosis.