监测颈内静脉血氧饱和度指导颅脑手术过度通气  

Application of SjvO_2 Monitor in Neurosurgery Ventilation to Reduce Intracranial Pressure

作　　者：孟春[1] 梁禹[1] 李恒林[1] 

机构地区：[1]天津市环湖医院,300060

出　　处：《天津医药》2007年第8期575-577,共3页Tianjin Medical Journal

摘　　要：目的:探讨颅脑手术全身麻醉期间过度通气程度的选择,以在降低颅内压的同时有效地维持脑氧供需平衡。方法:对30例颅脑占位性病变择期手术患者全身麻醉期间进行过度通气以降低颅内压,根据呼气末二氧化碳分压[呼末p(CO2)]将患者分为A、B和C3组,分别为正常组(4.6～4.9kPa)、轻度(4.1～4.5kPa)和中度(3.4～4.0kPa)过度通气组。分别采集颈内静脉血样,检测颈内静脉血氧饱和度(SjvO2),计算脑氧摄取值(CEO2),同时进行颅内压(ICP)监测。结果:与A组比较,B组SjvO2和CEO2变化不大,C组SjvO2降低,CEO2升高,差异有统计学意义(P<0.05或P<0.01)。随着呼末p(CO2)下降,与A组比较B组和C组ICP均显著性降低(P<0.01)。结论:在颈内静脉血氧饱和度监测下,可以调整过度通气程度,避免因其选择不当导致脑氧失衡,有利于颅脑手术患者的预后。Objective：To investigate the application of jugular venous oxygen saturation（SjvO2）monitor in neurosurgery anesthesia excessively ventilation to maintain the brain oxygen supply balance while reduces the intracranial pressure.Methods：Thirty ASAⅡ-Ⅲ neurosurgery patients were included in this study.According to [pET（CO2）],the patients were randomly divided into three groups,normal degree group [group A,pET（CO2）4.6-4.9 kPa],gently degree group [group B,pET（CO2）4.1-4.5 kPa],middle degree group [group C,pET（CO2）3.4-4.0 kPa].The blood samples of jugular vein were collected and the values of SjvO2 were detected.The valve of cerebral oxygen extraction（CEO2）was calculated.The intracranial pressure（ICP）was monitored during operation.Results：There were no significant differences in SjvO2 and CEO2 between A and B groups.The value of SjvO2 was significantly decreased and CEO2 was significantly increased in group C compare to those in group A and B（P 〈 0.05 or P 〈 0.01）.With decreasing of pET（CO2）,the level of ICP was significantly decreased in groups B and C compared to that of group A（P 〈 0.01）.Conclusion：By monitoring SjvO2,excessively ventilation can be adjusted to avoid disequilibrium of brain oxygen supply and to improve prognosis of neurosurgery.

关 键 词：血氧测定法 颈静脉 颅骨切开术 通气过度 降压 控制性 颅内压 

分 类 号：R651.15[医药卫生—外科学]