近红外光谱无创监测局部脑氧饱和度在重型颅脑损伤术后治疗中的应用研究

发布时间：2018-02-13 17:01

本文关键词： 近红外光谱无创监测脑局部氧饱和度重型颅脑损伤颅内压　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的通过近红外光谱技术实时无创监测重型颅脑损伤术后局部脑氧饱和度,探讨局部脑氧饱和度的变化规律以及与颅内压(ICP)之间的相关性。方法选择自2015年7月至2016年11月安徽医科大学附属安庆医院24例重度颅脑损伤急诊术后患者,采用近红外光谱与有创颅内压监测仪持续监测局部脑氧饱和度(rScO_2)、颅内压(ICP),同时使用多参数心电监护仪监测记录脉氧饱和度(Sp O_2)、平均动脉压(MAP)、脑灌注压(CPP),采用SPSS统计学分析监测结果的关联性。结果重度颅脑损伤预后程度和rScO_2有统计学意义,预后越好的组其rScO_2值越高,术后rScO_2早期会出现下降,最后随颅内高压缓解后再次呈上升趋势。但4例死亡患者伤rScO_2主要呈下降趋势,上升不明显。rScO_2与ICP呈显著负相关(r=-0.882,P0.001),rScO_2与CPP呈显著正相关(r=0.938,P0.001)。MAP与rScO_2、ICP、CPP的线性相关无统计学意义(P0.05),P值分别为0.173、0.135、0.171。在重型颅脑损伤患者治疗过程中,MAP、Sp O_2基本维持在正常范围内,只有在患者处于濒死状态时进行性降低。结论尽管目前临床上颅内监测方法以有创颅内压监护为主,但其价格昂贵,有导致颅内感染、出血甚至死亡的危险。而近红外光谱技术具有无创、方便及精确等特点,可以准确无创监测脑组织局部脑氧饱和度,rScO_2对缺氧特别敏感,能及时反映重度颅脑损伤术后脑缺血缺氧等代谢情况,可以作为一种判断重型颅脑损伤病情变化的指标。通过近红外光谱技术了解脑内氧代谢水平,对于重型颅脑损伤治疗及预后评估有着重要意义。
[Abstract]:Objective by near infrared spectroscopy in real time without invasive monitoring of regional cerebral oxygen saturation after severe head injury, to investigate the changes of regional cerebral oxygen saturation and intracranial pressure (ICP). The correlation between the methods from July 2015 to November 2016 in Anqing Hospital Affiliated to Medical University Of Anhui emergency surgery for 24 patients with severe craniocerebral injury, and using near infrared spectroscopy intracranial pressure monitor continuous monitoring of regional cerebral oxygen saturation (rScO_2), intracranial pressure (ICP), while the use of multi parameter ECG monitoring and recording pulse oxygen saturation (Sp O_2), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), using SPSS statistical correlation analysis of the monitoring results. The results of severe craniocerebral injury degree and prognosis of rScO_2 was statistically significant, the better the prognosis of group rScO_2 was higher, postoperative early rScO_2 will decline, and finally with the high pressure relief after intracranial again increased. Potential. But 4 cases of death in patients with rScO_2 injury mainly decreased, no significant increase of.RScO_2 was negatively correlated with ICP (r=-0.882, P0.001), rScO_2 had significant positive correlation with CPP (r=0.938, P0.001).MAP and rScO_2, ICP, CPP linear correlation was not statistically significant (P0.05), P = 0.173,0.135,0.171. in severe craniocerebral injury patients during the treatment, MAP, Sp and O_2 maintained in the normal range, only decreased in patients in dying state. Conclusion although the monitoring method of intracranial intracranial pressure in clinical care, but the price is expensive, due to intracranial infection, bleeding and even death in danger. Infrared spectroscopy is a non-invasive, convenient and accurate, can accurate noninvasive monitoring of regional cerebral oxygen saturation in brain tissue, rScO_2 is particularly sensitive to hypoxia, it can reflect the severe craniocerebral injury postoperative cerebral ischemia and hypoxia and metabolic. It can be used as an index for judging the severity of severe craniocerebral injury. It is important to understand the level of oxygen metabolism in the brain by NIR spectroscopy, which is of great significance for the treatment and prognosis of severe traumatic brain injury.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15

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