脑改良氧利用率、动静脉血乳酸差值监测对严重颅脑损伤患者的临床意义.docVIP

脑改良氧利用率、动静脉血乳酸差值监 测对严重颅脑损伤患者的临床意义 张承军陈小艳罗松付煜 广安市岳池县人民医院 ： 目的探讨脑改良氧利用率(BMOAJC)、动静脉血乳差值(VALa)检测在重型颅 脑损伤中的应用价值。方法采用前瞻性分析，选取2014年3月一2016年6月 在四川省广安市岳池县人民医院治疗的颅脑损伤患者94例，其中重型颅脑损伤 患者35例(重型组)，轻中型颅脑损伤患者59例(轻中型组)。重型组势性 24例，女性11例;平均年龄38. 91岁；致伤原因:道路交通伤22例，坠落伤13 例;颅脑损伤分类:硬膜下血肿5例，多发血肿9例，脑实质内血肿10例，脑疝 7例，颅底骨折4例。轻中型组男性39例，女性20例；平均年龄39. 02岁；致伤 原因:道路交通伤31例，坠落伤28例;颅脑损伤分类:破膜下血肿10例，多发血 肿12例，脑实质内血肿21例，脑疝9例，颅底骨折7例。采用全自动血气分析 仪检测患者BMO2UC和VALa水平，并分析BMO2UC和VALa水平与入院时格拉斯哥 昏迷评分(GCS)和病死率的相关性。结果 重型组患者BM0AJC和VAS分别为 (0. 21±0. 07) %和(-0. 18±0. 08) mmol/L,明显低于轻中型组患者 (P0. 05) ;94例入院时GCS评分为(8?10±2?63)分,Pearson相关分析结果显 示入院时GCS评分与BMO2UC和VALa呈负相关(r分别为-0. 655 -0.511, P0. 05) ;94例患者死亡26例，病死率为27.66%。死亡患者BMO2UC和VAS分 别为(0.15土0.06) %和(-0. 11 土0.07) mmol/L,明显低于未死亡患者 (P0. 05) 0结论重型颅脑损伤患者BM02UC和VALa明显降低,BM02UC和VALa在 一定程度可反映脑组织损伤程度，并在评估患者预后有一定的价值。 关键词： 颅脑损伤;脑改良氧;利用率;动静脉;血乳酸; ：2017-03-31 Clinical significance of monitoring BM02UC and arteriovenous blood lactate difference in patients with severe craniocerebral injury ZHANG Cheng-jun CHEN Xiao-yan LUO Song FU Yu Yuechi Peoples Hospital of Guangan; Abstract： Objective To explore the application value of brain meliorate oxygcn utilization rate (BM02UC) and arteriovenous blood lacta’tc difference in severe craniocerebral injury. Methods Retrospective analysis was carried out in 94 patients with craniocerebral in jury t reated in Yuechi Peoples Hospi Lal of Guang，an from Mar. 2014 to Jun. 2016. Among them were 35 pat ients with severe eraniocerebral injury (severe group) , and 59 patients with mild and moderatc craniocerebral injury (mild and medium group) ?There were 24 males and 11 females in the severe group, with an average age of 38. 91 years. Causes of injury included road traffic injuries in 22 cases and falling injury in 13 cases. Types of brain injury included subdural hematoma in 5 cases, multiple hematoma in 9 cases, intracerebral hematomci in 10 cases, herniation in 7 cases and skull base fracturc in 4 cases. In the mild and medium group, there were 39 males