创伤性颅脑外伤脑氧代谢变化的意义及其与预后的相关性

Cerebral Oxygen Metabolism Changes after Traumatic Brain Injury and Correlation with Clinical Prognosis

目的观察以急性重度颅脑损伤为主的多发伤患者创伤后脑氧代谢变化,探讨其与预后的相关性。方法根据格拉斯哥昏迷评分(Glasgow coma score,GCS)的诊断标准收治以急性重度颅脑损伤为主的多发伤患者26例,于伤后24h、48h、72h、96h采集颈内静脉球血及外周动脉血作血气分析,监测颈内静脉球血乳酸水平,计算伤后24h、48h、72h、96h的动脉-颈内静脉氧含量差(AJDO2),脑的氧摄取率(CEO2)。于患者治疗后3个月追踪观察其预后情况,根据格拉斯哥结局评分(GOS)标准,分为有意识组(中、重度残疾或完全恢复,3≤GOS≤5);无意识组(死亡或植物生存,GOS=1,2)。结果1.通过电话询问或地方管理部门(村委会,政府等)追踪治疗3个月后患者的预后情况统计病死率38.46%,生存率61.54%。2.AJDO2、CEO2、Lactate伤后24h即升高达到一高值之后有所下降,但维持在高水平。3.伤后早期AJDO2,Lactate对神经功能预后评估具负性预测价值(标准系数beta分别为-0.326,-0.273;P值分别为0.009,0.005)具有统计学意义。结论重度颅脑创伤后24h存在脑缺血、缺氧,早期存在脑氧合过度、脑充血;创伤早期监测脑氧代谢变化对判断预后具有重要的预测价值。

Objective To investigate cerebral oxygen metabolism changes in acute severe traumatic brain injury（sTBI） patients and to study the correlation of the changes with acute neurological severity and outcome 3 months after trauma. Methods The Glasgow coma score （GCS）of 26 patients was less than or equal to 8,all of whom were admitted within 24 hours after injury. The arterio-jugular difference of oxygen content（AJDO2） and cerebral extraction of oxygen（CEO2） were calculated by using arterial jugular difference at 24h,48h, 72h and 96h after injury. Meanwhile the arterious and jugular venous blood gas analysis and lactate were also recorded. Outcome was defined 3 months after injury by using Glasgow outcome score（GOS）. Those whose GOS was less than 3 （death or persistent vegetative）were considered （U）; Those whose GOS was more than 2 （moderate,severe disability; good recovery）were considered as consciousness （C）. There were two groups of patients：Group U and Group C. Results Firstly, 3 months after treatment,the death rate of the patients was 38.46% and survival rate was 61.54%. Secondly,AJDO2,CEO2 and lactate were incraesed on the first day after injury,and afterwards they had a slight decline but kept a high level. Thirdly,AJDO2 and lactate had an important prediction value in serious traumatic brain injury. Conclusion Patients with serious traumatic brain injury show cerebral hypoxia and ischemia during first 24 hours after injury. Early monitoring of cerebral oxygen metabolism changes has an important value in predicting prognosis of these patients.