亚低温治疗对重型脑损伤急性期脑氧分压和脑温的影响  

Effect of mild hypothermia on P _(bt) O_2 and BT of patients with severe head injury

作　　者：只达石[1] 张赛[1] 林欣[1] 陈荷红[1] 肖绪林[1] 苏晨方[1] 尚彦国[1] 牛玉德[1] 刘敬业[1] 张楷文[1] 毛瑞 曹海华[1] 杨谨涛[1] 马宁[1] 

机构地区：[1]天津市环湖医院,300060

出　　处：《中华神经外科杂志》2001年第1期38-40,共3页Chinese Journal of Neurosurgery

摘　　要：目的　研究重型脑损伤急性期脑组织氧分压 (PbtO2 )和脑温 (BT)的变化及亚低温治疗对PbtO2 和BT变化的影响。方法　重型脑损伤病人 18例 ,在伤后 1～ 2 0小时内行亚低温治疗 ,直肠温度 (RT)控制在 31 5℃～ 34 9℃ ,持续 1～ 7天 ,平均 5 7 7± 2 8 4小时。同时监测病人的PbtO2 和BT等指标。PbtO2 和BT监测使用LICOX Ⅱ型 (德国 )PbtO2 和BT代谢仪 ,分别用PbtO2 和BT探头置于无明显损伤的额叶白质内 (硬膜下 2 7～ 36mm深处 ) ,持续监测 1～ 5天 ,平均 5 4 8± 2 7 0小时。伤后 3个月时根据GOS评估法判定预后。结果　本组 18例病人脑损伤后 2 4小时内PbtO2 值 (9 6± 6 8mmHg)均明显低于正常值水平 (16～ 40mmHg)。亚低温治疗 2 4小时后PbtO2 显著提高到 2 8 7± 8 8mmHg ,伤后第 3天时仍稳定在正常值范围内。重型脑损伤急性期BT高于RT ,亚低温治疗使BT与RT差距增大。过度换气 (PaCO2 =2 5mmHg左右 )可降低脑损伤后的高颅压 ,但同时导致PbtO2 明显下降。结论　在重型颅脑损伤急性期应用PbtO2 和BT直接监测技术 ,安全可靠 ,对于判定病情以及指导亚低温和过度换气等治疗措施 ,具有重要意义。Objective To study the changes of partial pressure of brain tissue oxygen (P bt O 2) and brain temperature(BT) in acute phase of patients with severe head injury, and effect of mild hypothermia on P bt O 2 and BT. Methods P bt O 2 and BT of 18 patients with severe head injury were monitored, and hypothermia was induced within 20 hours of injury. Rewarming was begun on 1 7 days (average 57 7±28 4 hours) after the rectal temperature (RT) reached 31 5℃ 34 9℃. Monitorings of P bt O 2 and BT were lasted for 1 5 days (average 54 8±27 0 hours). According to Glasgow Outcome Scale (GOS), the prognosis of the patients was evaluated. Results Within 24 hours after severe head injury, P bt O 2 was significantly lower (9 6±6 8mmHg) than the normal value (16 40mmHg). BT was higher than RT. After treatment in mild hypothermia, mean P bt O 2 raised to 28 7±8 8 mmHg during the first 24 hours, and the P bt O 2 level was maintained within the range of normal value at the third day after injury. The difference between BT and RT significantly appeared in mild hypothermia. Hyperventilation (PaCO 2≈25mmHg) induced low P bt O 2 ever high ICP decreased. Conclusions This study demonstrates that monitoring of P bt O 2 and BT is a safe, reliable and sensitive diagnostic method for the patients with severe head injury. It might become an important tool in our treatment regime for acute patients of severe head injury during hypothermia and hyperventilation.

关 键 词：重型脑损伤 急性期 脑氧分压 脑温 亚低温治疗 

分 类 号：R651.15[医药卫生—外科学] R454.5[医药卫生—临床医学]