过度通气对严重颅脑伤手术患者脑氧供需平衡的影响  

Effects of hyperventilation on cerebral oxygen supply and consumption in perioperative patients with severe head injury and their significance

作　　者：程明华[1] 姚咏明[2] 

机构地区：[1]汕头大学医学院第一附属医院,广东汕头515041 [2]解放军第三○四医院,北京100037

出　　处：《中国中西医结合急救杂志》2003年第4期220-222,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家自然科学基金资助项目 (3 9870 2 86)

摘　　要：目的 :探讨过度通气对严重颅脑伤手术患者颈内静脉球血氧饱和度 (Sjv O2 )、脑动静脉氧含量差(A VDO2 )和脑静动脉血乳酸差 (V ADL )的影响及其临床意义。方法 :16例严重颅脑损伤急诊手术患者全身麻醉后 ,通过改变控制通气呼吸频率和吸入气氧分压调节过度通气水平 ,使每种通气水平维持稳定 15 m in后 ,均测定 Sjv O2 、A VDO2 以及 V ADL。结果 :当动脉血氧分压 (Pa O2 )为 10 0～ 15 0 mm Hg(1mm Hg=0 .133k Pa)和 2 0 0～ 2 5 0 m m Hg、动脉血二氧化碳分压 (Pa CO2 )从 30 mm Hg降至 2 5 mm Hg时 ,可使 Sjv O2 明显降低 ,A VDO2 明显升高 ,但 Pa O2 2 0 0～ 2 5 0 m m Hg与 Pa O2 10 0～ 15 0 m m Hg相比 ,Sjv O2 的绝对值均明显较高 ,A VDO2 绝对值明显较低。与基础值相比 ,Pa O2 10 0～ 15 0 mm Hg、Pa CO2 30 mm Hg及 2 5 mm Hg和Pa O2 2 0 0～ 2 5 0 mm Hg、Pa CO2 2 5 mm Hg时 V ADL 均明显升高。结论 :较高氧合 (Pa O2 2 0 0～ 2 5 0 m m Hg)和中度过度通气 (Pa CO2 30 m m Hg)对脑氧供需平衡无明显影响 。Objective: To investigate the effects of hyperventilation on jugular venous oxygen saturation (SjvO 2), arteriovenous oxygen content difference(A-VDO 2) and lactate concentration difference(V-ADL) perioperative patients with severe head injury and their significance. Methods: Sixteen patients with severe head injury for operation were studied. The changes of SjvO 2, A-VDO 2 and V-ADL in response to changes in partial pressure of oxygen in artery(PaO 2) and partial pressure of carbon dioxide in artery(PaCO 2) were studied through adjusting respiratory rate and fraction of inspired oxygen. Results: SjvO 2 decreased significantly and A-VDO 2 increased significantly when PaCO 2 deceased from 30 mm Hg to 25 mm Hg ( 1 mm Hg = 0 133 kPa ) at a PaO 2 of 100-150 mm Hg or 200-250 mm Hg. The absolute value of SjvO 2 was greater and the absolute value of A-VDO 2 was lower at a PaO 2 of 200-250 mm Hg for any given PaO 2. V-ADL did not change significantly only at a PaO 2 200-250 mm Hg and PaCO 2 30 mm Hg. Conclusion: Moderate hyperventilation to a PaCO 2 of 30 mm Hg in combination with higher PaO 2 (200-250 mm Hg) may be beneficial for patients with severe head injury.

关 键 词：过度通气 严重颅脑伤 手术 脑氧供需平衡 麻醉药物 围手术期 

分 类 号：R651.15[医药卫生—外科学]