PbtO_2联合颅内压多参数监测对急性重型颅脑损伤合并多发伤目标治疗的影响  

Effect of combined monitoring PbtO_2 and intracranial pressures on goal-directed therapy in severe traumatic brain injury patients whith multiple injuries

作　　者：王其平[1] 高恒[1] 那汉荣[1] 徐裕[1] 杨磊[1] 

机构地区：[1]东南大学医学院附属江阴医院神经外科,江苏省214400

出　　处：《江苏医药》2013年第22期2696-2699,共4页Jiangsu Medical Journal

基　　金：无锡市科技发展指导计划(CSZ00966)

摘　　要：目的探讨脑组织氧分压(PbtO2)联合颅内压(ICP)、平均动脉压(MAP)和中心静脉压(CVP)多参数监测指导重型颅脑损伤(sTBI)合并多发伤目标治疗的效果。方法对20例sTBI合并多发伤患者(GCS<8,ISS>16)应用PbtO2、ICP、MAP和CVP多参数监测;治疗目标:控制ICP<20mm Hg,维持脑灌注压(CPP)≥60mm Hg,PbtO2≥20mm Hg。分析疗效。结果治疗2、24、48和72h,PbtO2<20mm Hg的百分比均高ICP>20mm Hg,CPP<60mm Hg百分比(P<0.05)。在连续2640h的PbtO2监测期间,共有358次PbtO2下降(PbtO2<20mm Hg);医疗干预使78%的PbtO2下降得以纠正(PbtO2≥20mm Hg)。伤后6个月,GOS恢复良好8例,中残1例,重残2例,植物生存1例,死亡8例。结论 PbtO2联合ICP、MAP和CVP多参数监测能有效反映sTBI合并多发伤患者的脑缺氧状态,依据PbtO2为目标的治疗能够纠正脑缺氧,改善预后。Objective To investigate the effectiveness of combined monitoring brain tissue partial pressure of oxygen （PbtO2）, intracranial pressure （ICP）, mean arterial pressure （MAP） and central venous pressure（CVP） in goal-directed therapy in the patients with severe traumatic brain injury（sTBI） with multiple injuries. Methods The combined monitoring of PbtO2, ICP, MAP and CVP was performed in 20 TBI patients associated with extracranial injuries （GCS〈8, ISS〉 16）, in whom the goal of therapy was defined as keeping ICP〈20 mmHg, CPP≥60 mmHg, and PbtO2 20 mm Hg. The efficacy was analyzed. Results At 2,24,48 and 72 h during treatment, the percentages of PbtO2〈20 mmHg were lower than those of ICP〉20 mmHg and CPP〈60 mmHg（P〈0. 05）. During a continuous PbtCh mornitoring for 2640 hours, a total of 358 episodes of PbtO2 decrease 20 mmHg was found. The correction of PbtO2 decrease was realized in 78% of the episodes after therapeutic intervention. In the 6th month after injury, GOS assessment showed good recovery in 8 cases, moderate disability in 1 case, severe disability in 2 cases, vegetative status in 1 case and died in 8 cases. Conclusion The combined mornitoring of PbtCh, ICP, MAP and CVP can effectively detect brain hypoxia in sTBI patients associated with extracranial injuries. A PbtCh goal-directed therapy is helpful in correcting brain hvlooxia and imoroving the orognosis.

关 键 词：颅脑损伤 脑组织氧分压 

分 类 号：R651[医药卫生—外科学]