重型颅脑损伤的亚低温治疗及局部脑氧饱和度的意义.docVIP

重型颅脑损伤的亚低温治疗及局部脑氧饱和度的意义 吴坚平 任达安 曹同瓦 复旦大学附属华山医院重症医学科，上海 200040 ? [摘要] 目的 探讨亚低温治疗对重型颅脑损伤患者局部脑氧饱和度（rSO2）及颈静脉氧饱和度（SjO2）变化的影响。方法 选取收入华山医院ICU的GCS≤6分的重型颅脑损伤患者，均于伤后24hr内尽早给予亚低温治疗，使亚低温核心温度在32~34℃维持48hr，然后逐渐缓慢复温，同时监测rSO2及SjO2在亚低温开始时、到达亚低温温度时、亚低温24hr、48hr及复温后的各项指标。结果 亚低温治疗可使颈颈静脉血的SjO2数值较治疗前显著上升（P0.05），复温后SjO2的数值较亚低温治疗时有所下降，但较治疗前相比仍有显著差异，同样脑氧饱和度rSO2变化与SjO2的数值变化一致。结论 对重型颅脑损伤病人实行亚低温治疗可改善脑代谢，防止脑缺血的继发性损害。rSO2与SjO2有良好的相关性，无创持续监测rSO2能反映颅脑损伤后脑氧代谢，能作为临床上切实可行的亚低温治疗的监测指标。 [关键词] 亚低温，治疗，氧饱和度，重型颅脑损伤，预后 Effect of moderate hypothermia treatment on severe brain injury and significance of regional cerebral oxygen saturation [Abstract] Objective To study the changes in regional cerebral oxygen saturation and jugularvenous oxygen saturation after moderate hypothermia treatment in patients with severe brain injury. Methods Moderate hypothermia were used on 22 patients with severe brain injury (GCS≤6) in the intensive care unit of Hua Shan Hospital. The treatment was all began within 24 hours after injury. The core temperature was maintained at 32~34℃ for 48 hours, and then was rewarmed gradually. Regional cerebral oxygen saturation and jugularvenous oxygen saturation of each patient were monitored at five time points: prior to inducing hypothermia, obtaining hypothermia, after 24 and 48 hours of hypothermia and after rewarming. Results Jugularvenous oxygen saturation was significantly higher after moderate hypothermia than prehypothermia（P0.05）. Jugularvenous oxygen saturation was slightly lower after rewarming than after hypothermia, but it was also higher than prehypothermia. The results of regional cerebral oxygen saturation were significantly correlated with the jugularvenous oxygen saturation. Conclusions Moderate hypothermia treatment on patients with severe brain injury can improve the cerebral metabolism and prevent secondary brain ischemic injury. rSO2 is significantly correlated with SjO2, reflecting cerebral oxygen metabolism. Noninvasive continuance monitoring of rSO2 can be us