早期机械通气联合亚低温在重型颅脑损伤治疗中的应用研究  

Application study of early ventilation combined mild hypothermia hibernation on patients with severe traumatic brain injury

作　　者：蔡玲芬 钟丽华 金玲江 林达 尹康 何文根 杨建萍 徐茹 林正 

机构地区：[1]浙江省温岭市第一人民医院脑外科,浙江温岭317500

出　　处：《中国医药导报》2013年第15期51-53,57,共4页China Medical Herald

基　　金：浙江省温岭市科技计划项目(编号2012C31096)

摘　　要：目的探讨早期机械通气联合亚低温在重型颅脑损伤(STBI)患者治疗中的应用及其临床效果。方法选择116例STBI患者,随机分为对照组及治疗组,对照组依据病情给予呼吸支持,治疗组给予早期机械通气联合亚低温治疗,两组患者均依据病情给予外科治疗或保守治疗,连续监测两组患者脑灌注压(CPP)、颈静脉血氧饱和度(SjvO2)、脑组织氧分压(PbtO2)、脑动静脉氧压差(AVDO2)及脑组织摄氧率(CERO2),比较两组间不同时间点的差异。并对患者预后进行随访,比较患者康复情况。结果两组患者治疗前CPP、SjvO2、PbtO2、AVDO2及CERO2无差异,治疗后6、12、24、48 h及72 h,治疗组CPP分别为(67.0±7.2)、(65.9±7.4)、(71.4±9.1)、(78.2±12.6)、(75.9±10.7)mm Hg,对照组CPP分别为(55.4±6.9)、(55.4±6.9)、(49.6±5.6)、(51.9±8.0)、(56.4±7.8)mm Hg,治疗后各时间点治疗组CPP高于对照组(6 h t=4.31,P=0.006;12 h t=5.25,P=0.003;24 h t=7.10,P=0.000;48 h t=10.39,P=0.000;72 h t=5.10,P=0.002),治疗组SjvO2分别为(0.48±0.11)%、(0.52±0.16)%、(0.56±0.12)%、(0.54±0.12)%、(0.58±0.14)%,对照组SjvO2分别为(0.40±0.11)%、(0.38±0.12)%、(0.36±0.14)%、(0.32±0.13)%、(0.38±0.11)%,治疗组各时间点SjvO2高于对照组(6 h t=4.28,P=0.005;12 h t=4.79,P=0.004;24 h t=4.29,P=0.005;48 h t=3.84,P=0.009;t=4.26,P=0.005),治疗组PbtO2分别为(34.7±4.0)%、(35.2±3.8)%、(37.6±3.2)%、(39.2±4.1)%、(40.6±3.7)%,对照组PbtO2分别为(31.2±3.1)%、(28.4±3.3)%、(30.6±3.6)%、(29.5±3.9)%、(33.6±4.0)%,治疗后各时间点治疗组PbtO2高于对照组(6 h t=4.10,P=0.009;12 h t=3.82,P=0.010;24 h t=11.03,P=0.000,48 h t=6.14,P=0.002;72 h t=3.17,P=0.012),治疗组AVDO2分别为(3.84±0.33)、(3.34±0.35)、(3.28±0.29)、(3.16±0.22)、(3.19±0.34)mm Hg,对照组AVDO2分别为(4.92±0.51)、(5.30±0.47)、(5.46±0.35)、(5.31±0.40)、(5.38±0.51)mm Hg,各时间点治疗组AVDO2低于对照组(6 h t=6.02,P=0.002;12 h t=4.06,P=0.007;24 h t=8.02,P=0.001;48 h t=4.09,P=0.Objective To investigate the application and clinical curative effect of early ventilation combined mild hy pothermia hibernation on patients with severe traumatic brain injury（SIBI）.Methods 116 cases of patients with STBI were selected and randomized into control group and therapia group,patients in control group taken respiration support acoording pathogenetic condition,patients in therapia group taken early ventilation combined mild hypothermia hiber nation,all patients taken surgical therapy or expectant treatment according pathogenetic condition,and monitorcerebral perfusion pressure（CPP）,O2 suturation of jugular venous blood（SjvO2）,O2 partial pressure of brain tissue（PbtO2）,arteriovenous oxygen content difference（AVDO2）and cerebral oxygen consumption rate（CERO2）,and different were contrasted between control group and therapia group in different time,all patients were followed up for prognosis,and re habilitation conditions were contrasted between control group and therapia group.Results CPP,SjvO2,PbtO2,AVDO2 and CERO2 was identical before therapay between control group and therapia group,at 6 h,12 h,24 h,48 h and 72 h after therapay after therapay,CPP was（67.0±7.2）,（65.9±7.4）,（71.4±9.1）,（78.2±12.6） and（75.9±10.7） mm Hg in therapia group,and was（55.4 ±6.9）,（55.4±6.9）,（49.6±5.6）,（51.9±8.0） and（56.4 ±7.8）mm Hg in control group,CPP was higher in herapia group than in control group at different time（6 h t = 4.31,P = 0.006;12 h t = 5.25,P = 0.003;24 h t = 7.10,P = 0.000;48 h t = 10.39,P = 0.000;72 h t = 5.10,P = 0.002）,SjvO 2 was（0.48±0.11）%,（0.52±0.16）%,（0.56±0.12）%,（0.54±0.12）% and（0.58±0.14）% in therapia group,and was（0.40±0.11）%,（0.38±0.12）%,（0.36±0.14）%,（0.32±0.13）% and（0.38±0.11）% in control group,SjvO 2 was higher in therapia group than in control group at different time（6 h t = 4.28,P = 0.005;12 h t = 4.79,P = 0.004;24 h t = 4.29,P = 0.005;48 h t = 3.84,P = 0.009;t = 4.26,P = 0

关 键 词：重型颅脑损伤 亚低温 机械通气 预后 

分 类 号：R651.15[医药卫生—外科学]