颈内静脉血氧利用率、二氧化碳分压、乳酸与动脉血差值联合测定在早期重型颅脑损伤病人变化及意义

The change and significance of arteriovenous difference of lactic acid and carbon dioxide,oxygen utilization coefficient in the internal jugular vein in early stage of severe brain injury

目的观察颈内静脉血氧利用率(O2UC);颈内静脉血二氧化碳、乳酸与动脉血净差值(VAPCO2,VALa)在早期重型颅脑损伤病人中变化及评价它们反映全脑氧代谢改变中的意义。方法比较颈内静脉血二氧化碳、乳酸与动脉血差值(VAPCO2、VALa)、氧利用率(O2UC)在病情轻重间差别。结果①重型、轻中型颅脑损伤病人颈内静脉血VAPCO2均为正值,且轻型病人增加量较重型多,两者比较差异有统计学意义,P<0.05;VALa重型病人颈内为负值,轻中型病人均为正值,两组比较差异有统计学意义,P<0.05。O2UC数值重型组比轻中型组小,两两比较差异有统计学意义,P<0.05。结论重型颅脑损伤病人表现为低O2UC、低VAPCO2、负VALa,是早期颅脑损伤病情极重的标志。颈内静脉血血气、乳酸监测全脑氧代谢变化有临床价值。

Objective To observe the change of oxygen utilization coefficient （ O2UC） of internal jugular vein, to investigate arteriovenous difference of lactic acid （VALa） and carbon dioxide （ VAPCO2 ） in the internal jugular vein in early stage of severe brain injury and evaluate their significance in reflecting the oxygen metabolic changes of the brain. Methods To compare the O2 UC, VAPCO2 and VALa in internal jugular vein the severity of the disease. Results VAPCO2 in patients with both severe and mild - to - middle brain injury was positive. The net value of difference in mild - to - middle brain injury was greater than that of severe brain injury. The difference was obvious with P 〈 0.05. VALa was negative in patients with severe brain injury, while VALa was positive in patients with mild - to - middle brain injury. The difference between the two group was obvious with P 〈 0. 05 . O2UC in mild- to- middle brain injury was greater than that of severe brain injury. The difference was obvious with P 〈0.05. Conclusion Patients with severe brain injury exhibited low O2UC, low VAPCO2 and negative VALa, which are all positively correlated with that of internal jugular vein, which is an indication of serious condition of brain injury in early stage. Blood - gas and lactic acid monitoring of internal jugular vein is an alternative approach in cerebral oxygen metabolism monitoring with clinical value.