机械通气辅助及血压调控对重症颅脑损伤患者脑氧代谢的影响

Effects of Mechanical Ventilation Together with Blood Pressure under Control on Cerebral Oxygen Metabolism in Severe Traumatic Brain Injury Patients

目的观察机械通气辅助及血压调控对重症颅脑损伤患者脑氧代谢的影响。方法56例重症颅脑外伤患者(3<GCS≤8),随机分为两组(n=28):对照组(Ⅰ组)和治疗组(Ⅱ组)。行气静复合全身麻醉,术毕回ICU,Ⅰ组按颅脑损伤常规治疗,Ⅱ组加用机械通气及血压调控治疗。观察患者各时点的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR),并抽取桡动脉和颈内静脉球处血液行血气分析,根据Fick公式计算脑氧摄取率(ERO2),并在伤后3个月根据格拉斯哥预后积分(GiasgowOutcome Scale,GOS)判定病人预后。结果Ⅱ组患者的脑氧摄取率在术后6、12、24、48、72 h比Ⅰ组显著降低(P<0.01);Ⅱ组患者伤后3个月死亡率比Ⅰ组明显降低(P<0.05),生存质量明显改善(P<0.05)。结论机械通气辅助及血压调控可使脑氧摄取率明显降低,3个月的预后明显改善。

Objective To investigate the effects of mechanical ventilation together with blood pressure under control on cerebral oxygen metabolism in patients with severe traumatic brain injury（STBI）.Methods 56 patients with severe traumatic brain injury（3〈GCS≤8） were randomly divided into the control group（group I,n=28） and the therapy group（group II,n=28）.In group I,patients were treated according to conventional therapy.In group II,patients were treated by mechanical ventilation together with blood pressure under control.The SBP,DBP,MAP,HR were observed before narcosis（T0）,1 hour after induction（T1）,immediately after surgery（T2）,postoperative 6 hour（T3）,12 hour（T4）,12 hour（T5）,12 hour（T6） and 12 hour（T7）.At the same time blood was collected from radial artery and jugular bulb venous for blood gas analysis,and the oxygen content of artery（CaO2）,oxygen content of jugular venous（CjvO2） and cerebral metabolic rate for oxygen（CERO2） were calculated.The prognosis of patients were determined according to the Giasgow Outcome Scale（GOS） after 3 months.Results The oxygen supply was significantly better after general anesthesia induction,cerebral oxygen metabolic rate was lower than before anesthesia induction in the two groups,but CERO2 was more significantly decreased at postoperative in group II than in group I（P〈0.01）6,12,24,48,72 h after operation.According to GOS scores at the 3th month after treatment,the living quality in the group II is better than that in group I（P〈0.05）,and the death rate is significantly decreased（P〈0.05）.Conclusion There is more significant decrease in CERO2 in patients with STBI when treated by mechanical ventilation together with blood pressure under control than treated according to conventional therapy,and it can be more significantly.It is more beneficial to the prognosis of patients.