颈内静脉血氧饱和度与颅脑损伤预后的关系

Relationship between oxyhemoglobin saturation in internal jugular vein （cerebral extraction of oxygen） and prognosis of head injury

目的 观察颈内动-静脉血气分析、算出脑氧摄取率,并探讨颈内静脉血氧饱和度及脑氧摄取率与颅脑损伤预后的关系.方法 泰州市人民医院ICU收治的重型颅脑损伤患者70例,在经过紧急处理如保持呼吸道通畅、保证供氧、维持循环稳定,以及及时的开颅手术治疗后24 h抽取颈内动-静脉血进行血气分析.选轻度颅脑损伤患者80例作为对照组.观察分析指标有颈内动脉血氧饱和度（SaO2）、氧分压（PaO2）,颈内静脉血氧饱和度（SjvO2）、氧分压（PjvO2）,颈内动脉二氧化碳分压（PaCO2）、颈内静脉二氧化碳分压（PjvCO2）、颈内动-静脉血氧饱和度差（Sa-jvO2）=SaO2-SjvO2、颈内动-静脉氧分压差（Pa-jvO2）、颈内动-静脉二氧化碳分压差（Pa-jvCO2）、颈内动脉血氧含量（CaO2）、颈内静脉血氧含量（CjvO2）、颈内动-静脉血氧含量差（Ca-jvO2）=CaO2-CjvO2,脑氧摄取率（%）CEO2=Ca-ivO2/CaO2.结果 重度颅脑损伤患者较轻度颅脑损伤患者颈内静脉血气分析中SivO2,PjvO2差异具有统计学意义（P〈0.05）,另外Sa-jvO2,Pa-jvO2,Ca-jvO2,CEO2差异具有统计学意义（P〈0.05）.结论 SjvO2与CEO2联合分析能科学地表示脑组织摄氧量或耗氧量,能较好地反映颅脑损伤的预后.

Objective To observe blood gas analysis of internal carotid artery and internal jugular vein to calculate the cerebral extraction of oxygen, and to investigate the relationship between oxyhemoglobin in internal jugular vein, cerebral extraction of oxygen, and the prognosis of patients with head injury. Method Seventy patients with acute severe head injury in ICU of Taizhou People Hospital were studied, and another 80 patients with mild head injury were enrolled as controls. Twenty-four hours after first aid such as keeping airway open and circulatory and ventilation support, and emergency craniotomy, the blood samples from internal carotid artery and internal jugular vein were collected for blood gas analysis including SaO2, PaO2, SjvO2, PJVO2 〉 PaCO2, PJVCO2, SaO2-SjvO2, Pa-jvCCO2, CaO2-CjvO2 and Ca-jvO2/CaCO2 （CEO2, cerebral oxygen extraction）. Results There were significant differences in SjvO2, PjvO2, Sa-jvO2, Pa-jvO2 Ca-jvO2 and CEO2 between two groups. Conclusions The SjvO2 and CEO2 represent the cerebral oxygen uptake and oxygen consumption precisely, and they can be used to predict the outcome of patients with severe craniocerebral trauma commendabiy.