颈静脉氧饱和度和动静脉乳酸差值在重型颅脑损伤患者中的临床意义

发布时间：2018-02-21 02:49

  本文关键词： 重型颅脑损伤 动静脉乳酸差值 颈内静脉氧饱和度 脑灌注压 预后　出处：《复旦大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：重型颅脑损伤常伴有早期脑灌注不足。通过动态监测重型颅脑损伤患者的动静脉乳酸差值(arteriojugular venous lactate difference, AVDL)和颈静脉血氧饱和度(jugular blood oxygen saturation,SjvO2),希望发现：1)伤后早期是否存在SjvO2和AVDL的异常；2)异常的SjvO2和AVDL与预后的关系；3)低灌注是早期脑缺血的最常见病因,低灌注的标准及SjvO2和AVDL与脑灌注压(cerebral perfusion pressure, CPP)水平是否存在相关性。方法：35例重型颅脑损伤病人伤后3天内每6小时抽取股动脉和颈静脉球血样本,监测平均动脉压(mean arterial pressure, MAP)、颅内压(intracranial pressure, ICP)、SjvO2、乳酸值,计算AVDL、 CPP。本研究分为重型颅脑损伤组(GCS 3—8分)和对照组(无颅脑损伤,麻醉延迟复苏),重型颅脑损伤组根据随访半年后GOS评分,分为预后良好组和预后不良组。统计分析各组间SjvO2和AVDL的差异,同时分析SjvO2和AVDL等指标与CPP水平的相关性。结果：采集478例血样本,测定重型颅脑损伤组SjvO2均值为0.549±0.086,对照组SjvO2均值为0.622±0.013,重型颅脑损伤组AVDL均值为-0.321±0.078mmol/L,对照组AVDL均值为-0.284±0.062 mmol/L。35例重型颅脑损伤病人AVDL、SjvO2异常值监测发现Sjv02≥75%出现一次为3例(9%),多次2例(6%),SjvO2≤50%出现一次为5例(16%),多次6例(17%),出现病理性AVDL一次为5例(16%),多次5例(16%)。重型颅脑损伤患者中预后良好组监测SjvO2在50%～75%之间者与出现SjvO2患者相比较,经Fiser's确切概率法检验,前者预后好于后者,双、单侧精确概率均为0.042,有统计学意义。SjvO2 50%～75%者与SjvO2≤50%者相比较,前者预后好于后者,X2=6.903,P=0.009,有统计学意义。重型颅脑损伤患者中出现生理性AVDL的预后好于出现病理性AVDL,两者相比较X2=5.303,P=0.021,有统计学意义。在CPP60mmHg时,经检验SjvO2与CPP呈正相关,相关系数r=0.743,p0.01。当CPP60mmHg时,经检验AVDL与CPP呈负相关,相关系数r=-0.379,p0.01。结论：重型颅脑损伤患者监测发现SjvO2≤50%, SjvO2≥75%或病理性AVDL,预后欠佳。SjvO2和AVDL与重型颅脑损伤患者合并低灌注有明确的相关性,可作为病情监测的有效指标。
[Abstract]:Objective: severe craniocerebral injury is often associated with early cerebral perfusion insufficiency. By dynamic monitoring of arteriovenous venous lactate difference (AVDL) and jugular blood oxygen saturation of jugular blood oxygen saturation (VO2) in patients with severe craniocerebral injury (CBI), we hope to find that the early stage after V1 was found to be. The relationship between abnormal SjvO2 and AVDL and prognosis. Low perfusion is the most common cause of early cerebral ischemia. There was no correlation between SjvO2 and AVDL and cerebral perfusion pressure (CPPs). Methods femoral and jugular globus blood samples were taken from 35 patients with severe craniocerebral injury every 6 hours in 3 days after injury. Mean arterial pressure.MAPP, intracranial pressure, intracranial pressure, ICPU SjvO2, lactic acid value, AVDL, CPP.This study was divided into severe craniocerebral injury group (GCS3-8 score) and control group (no craniocerebral injury, anaesthesia delayed resuscitation), severe craniocerebral injury group according to the GOS score after half a year follow-up. The difference of SjvO2 and AVDL was statistically analyzed, and the correlation between SjvO2, AVDL and CPP level was analyzed. Results: 478 blood samples were collected. The mean value of SjvO2 was 0.549 卤0.086 in severe craniocerebral injury group, 0.622 卤0.013 in control group, -0.321 卤0.078 mmol / L in severe craniocerebral injury group, and -0.284 卤0.062 mmol/L.35 in control group. There were 5 cases with SjvO2 鈮，

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