颅脑创伤患者早期动态监测血碱剩余水平对判断预后的价值  

The value of early base excess monitoring on predicting prognosis in traumatic brain injury patients

作　　者：卢清龙 高静 侯运辉 马增香 王文生 贾利静 魏晓华 杨丽丽 要莉莉 

机构地区：[1]河北省沧州市人民医院重症医学科,061001

出　　处：《中国医师进修杂志》2012年第35期34-36,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的动态监测颅脑创伤患者入院后3d内血碱剩余（BE）水平的变化，评估血BE水平对预后的影响。方法选取颅脑创伤患者56例，监测人院后3d内动脉血BE水平，按入院即刻格拉斯哥昏迷量表（GCS）评分将患者分为轻型（13-15分）组15例、中型（9，12分）组22例、重型（3～8分）组19例，按预后分为死亡组14例与存活组42例，以人院后3d内血BE水平分为高BE（≥-8mmol／L）组35例和低BE（〈-8mmol／L）组21例，比较评估血BE水平与患者病情严重程度、预后的关系。结果轻、中、重型组患者入院后1、2、3d血BE水平较入院即刻出现不同程度的升高，轻型组[（-3．02±0．21）mmol／L]、重型组[（-9．64±1．19）mmol／L]分别与中型组[（-8．49±1．44）mmol／L]比较差异有统计学意义（P〈0．01）；死亡组患者入院即刻、人院后1、2、3d血BE水平均显著低于存活组[（-11．97±2．13）mmol／L比（-6．29±1．16）mm01]L，（-9．84±1．33）mmol／L比（-4．89．4-1．78）mmol／L，（-8．78±2．01）mmol／L比（-3．61±1．43）mmol／L，（-7．84±1．42）mmol/L比（-3．10±0．98）mmol／L]（P〈0．01）；低BE组入院即刻急性生理和慢性健康状况Ⅱ评分、病死率均高于高BE组[（24．84±3．68）分比（16．27±2．21）分；52．4％（11／21）比8．6％（3／35）]（P〈0．01），人院即刻GCS评分低于高BE组[（7．56±3．09）分比（10．51±2．43）分]（P〈0．01）。结论早期动态监测血BE水平是评价颅脑创伤患者治疗效果及预测预后的简单而有效的指标，值得临床推广应用。Objective To dynamically monitor the base excess（BE） in traumatic brain injury（TBI） patients within 3 d after admission, and to assess the impact of the early BE on prognosis. Methods Blood BE was monitored for 3 d in 56 TBI patients. Patients were classified into mild group（ 15 patients）, moderate group （22 patients） and severe group （19 patients） according to the scores of Glasgow coma scale（GCS）. Patients were classified into survival group（42 patients） and dead group（ 14 patients） according to prognosis. Patients were classified into high BE group （35 patients, BE ≥-8 mmol/L） and low BE group （21 patients, BE 〈 -8 mmol/L）. The relations among BE,degree of injury and prognosis were analyzed. Results The level of BE in mild group, moderate group and severe group was increased after treatment for 1,2,3 d than that before treatment.The level of BE was consistent with the degree of injury [mild group： （-3.02 ± 0.21 ） mmol/L; moderate group： （-8.49 ±1.44） mmol/L; severe group： （-9.64 ± 1.19 ） mmol/L ]. The level of BE in mild group and severe group had significant difference than that in moderate group （P 〈 0.01 ）. The level of BE in dead group before treatment and after treatment for 1,2,3 d was significantly lower than that in survival group [（-11.97 ± 2.13） mmol/L vs. （-6.29 ± 1.16） mmol/L, （-9.84 ± 1.33） mmol/L vs. （-4.89 ± 1.78） mmol/L, （-8.78 ± 2.01 ） mmol/L vs. （-3.61 ± 1.43 ） mmol/L, （-7.84± 1.42） mmol/L vs. （-3.10 ± 0.98） mmol/L] （P 〈 0.01 ）. The scores of APACHE II before treatment and fatality rate in low BE group were significantly higher than those in high BE group [ （24.84 ± 3.68） scores vs. （ 16.27 ± 2.21 ） scores, 52.4% （11/21 ） vs. 8.6%（3/35 ）] （P 〈 0.01 ）. The scores of GCS before treatment in low BE group was significantly higher than that in high BE group [ （7.56 ± 3.09 ） scores vs. （ 10.51 ± 2.43 ） scores ] （P 〈 0.01 ）. Conclusion The level

关 键 词：颅脑损伤 预后 碱剩余 

分 类 号：R651.15[医药卫生—外科学]