严重颅脑损伤患者脑改良氧利用率及动静脉血乳酸差值的监测及意义  

Monitoring and significance of brain modified oxygen utilization coefficient in severe brain injury

作　　者：果应菲[1] 秦宇红[1] 张宪[1] 姚咏明[1] 赵晓东[1] 

机构地区：[1]解放军总医院第一附属医院急救部,北京100048

出　　处：《创伤外科杂志》2015年第2期109-112,共4页Journal of Traumatic Surgery

摘　　要：目的探讨脑改良氧利用率（BMO2UC）、动静脉血乳酸差值监测对严重颅脑损伤患者的临床意义。方法多种原因引起的颅脑损伤患者119例（其中严重颅脑损伤75例）,在链式流程急救复苏、呼吸循环支持后,生命体征平稳,动脉血氧饱和度（Sa O2）达0.98-1.0时,通过颈内静脉穿刺插管采血,测定颈内静脉血氧饱和度（Sj O2）及乳酸水平,计算出脑改良氧利用率和动静脉血乳酸差值并分析它们与格拉斯哥昏迷评分（GCS）及大脑皮质直接损伤间的关系。结果脑改良氧利用率、动静脉血乳酸差值水平与入院、出院时GCS均呈正相关（r=0.82,r=0.86;r=0.80,r=0.82）。有大脑皮质直接损伤组患者脑改良氧利用率及动静脉血乳酸差值水平低于无大脑皮质直接损伤组。结论严重颅脑损伤患者脑灌注压稳定在正常范围时,脑改良氧利用率下降及动静脉血乳酸差值水平低是脑组织损伤轻重程度的重要标志,并可以评估患者预后。Objective To explore the significance of monitoring brain modified oxygen utilization coefficient（ BMO2UC） and arteriovenous difference of lactic acid（ VALa） in severe brain injury. Methods Totally 119patients（ including 75 patients with severe brain injury） with brain injury were selected. The vital signs were stabilized after circulation and ventilation supported with the chain-step resuscitation,and the saturation of arterial blood（ Sa O2） was maintained 0. 98-1. 0. Jugular bulb oxyhemoglobin saturation（ Sj O2） and level of lactic acid（ Lac） was measured from blood sample with jugular catheter. The difference of Sa O2 and Sj O2（ BMO2UC） and the difference of arterial and venous lactic acid（ VALa） were relatively calculated. Furthermore,the relationship of BMO2 UC and VALa with Glasgow coma scale（ GCS） at admission or discharge and direct cerebral cortex injury were analyzed. Results BMO2 UC and VALa were positively correlated with GCS at admission or discharge（ r = 0. 82,r = 0. 86; r =0. 80,r = 0. 82）. BMO2 UC and VALa of patients with direct cerebral cortex injury were significantly lower than those of patients without direct cerebral cortex injury. Conclusion When the cerebral perfusion pressure of patients are stable,the decrease of BMO2 UC and VALa might reflect the degree of the brain injury,and might be helpful in the evaluation of the patients＇ prognosis.

关 键 词：颅脑损伤 脑改良 氧利用率 氧代谢 血乳酸 

分 类 号：R651.1[医药卫生—外科学]