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目的探讨颈静脉血氧饱和度对重型颅脑损伤患者的预后评估。方法选择我科收治的23例重型颅脑损伤患者,进行颈内静脉导管采血,同时穿刺桡动脉留置导管监测动脉血氧饱和度(SaO2),并计算动-静脉血氧饱和度差(SajO2),每6-8h或颅脑体征发生较大变化时分别采血送检;并特别采集急性脑损伤后24h血样。通过颈内静脉血气和桡动脉血气,计算颈内静脉氧饱和度(SjvO2)、脑氧摄取(CEO2)和动静脉氧含量差(AVDO2)。为观察SjvO2与预后的关系,将病例分为死亡组和存活组,观察期限为病人死亡或出院为止。结果死亡组与存活组SjvO2、CEO2、AVDO2变化:除伤后1 d以外,伤后2-5 d死亡组和存活组的SjvO2、CEO2和AVDO2间差异均有统计学意义(P均<0.05)。结论颈静脉氧饱和度的监测结合CEO2、AVDO2的变化分析,可以间接反映重型颅脑损伤患者脑组织血流及氧代谢功能情况,反映病情,评估预后。
Objective To evaluate the prognosis of severe craniocerebral injury in patients with jugular venous oxygen saturation. Methods Twenty-three patients with severe craniocerebral injury who were admitted to our department were enrolled in this study. Blood samples were taken from the internal jugular vein catheterization and radial artery catheterization was performed to monitor the arterial oxygen saturation (SaO2). The arterial-venous oxygen saturation difference (SajO2) , Every 6-8h or significant changes in signs of brain blood were seized for testing; and in particular 24h after acute brain injury blood samples. The internal jugular vein oxygen saturation (SjvO2), cerebral oxygenation (CEO2) and arteriovenous oxygen difference (AVDO2) were calculated from the jugular and radial arterial blood gases. To observe the relationship between SjvO2 and prognosis, the cases were divided into death group and survival group. The observation period was the death or discharge of the patient. Results The changes of SjvO2, CEO2 and AVDO2 between death group and survival group: There were significant differences in SjvO2, CEO2 and AVDO2 between death group and survival group 2-5 days after injury except 1 day after injury (all P <0.05) . Conclusion The monitoring of the oxygen saturation of jugular vein combined with the changes of CEO2 and AVDO2 can indirectly reflect the cerebral blood flow and oxygen metabolism in patients with severe craniocerebral injury, reflecting the condition and assessing the prognosis.