手术治疗急性重型颅脑损伤患者的意义及其脑组织氧分压变化  

Change and Clinical Significance of Continuous Monitoring of Partial Pressure of Oxygen in Brain Tissue in Patients with Acute Severe Brain Injury by Surgery

作　　者：林劲芝[1] 瞿文军[2] 柯以铨[1] 罗衡山[3] 王墨[3] 

机构地区：[1]南方医科大学珠江医院神经外科,广州510282 [2]广州医学院第一附属医院神经外科,广州510120 [3]广东省第二人民医院神经外科,广州510317

出　　处：《热带医学杂志》2010年第5期542-544,共3页Journal of Tropical Medicine

基　　金：广东省科技计划项目(No.93061)

摘　　要：目的探求手术治疗重型颅脑损伤患者脑组织氧分压(PbtO2)变化的临床意义。方法对42例急性重型脑损伤患者(均在全麻下急诊行血肿清除术和/或去骨瓣减压术),并且符合GCS≤8分,术前以及术后行PbtO2持续监测,同时行血电解质、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PcaO2)测定;分析PbtO2变化的临床意义。结果预后良好及预后不良组经过手术的干预,8、24、48、72h后PbtO2均明显升高,与术前相比差异有统计学意义(P<0.05);而在预后死亡组中,术后8、24、48hPbtO2与术前相比差异均无统计学意义(P>0.05)。没有发生与插入监测电极相关的并发症。结论脑组织氧分压测定是一种安全、灵敏、可靠的局部脑组织氧监测方法,可反映出重型脑损伤后的脑组织缺血缺氧情况,对临床治疗具有重要的指导作用。持续脑组织氧分压监测可判断重型脑外伤患者预后。Objective To evaluate the clinical significance of continuous monitoring of partial pressure of oxygen in brain tissue（PbtO2） in patients with acute severe brain injury by surgery. Methods 42 patients （Glasgow Coma Scale Score≤8） undergoing emergency removal of intracranial hematomas and / or decompressive craniotomy with general anesthesia,were monitored for the PbtO2 before and after surgery,while blood electrolytes,PaO2 and PaCO2 were measured at same time. The changes of PbtO2 were analyzed. Results （1）PbtO2 values ≤10 mmHg after trauma were negatively correlated with unfavourable outcome of the patients. （2）After the operation,patients with PbtO2 values 5 mmHg resulted in a significant increase （P 0.05）. （3） No complication was associated with the monitoring probe. Conclusion （1）Continuous monitoring of PbtO2 is a safe,sensitive and reliable method. It can reflect the ischemia-induced hypoxia of brain tissue after severe brain injury,and it is also helpful for the optimal management of brain injury.（2）Continuous monitoring of cerebral oxygenation may predict prognosis of severe brain injury.

关 键 词：重型颅脑损伤 脑组织氧分压 

分 类 号：R651.15[医药卫生—外科学]