对重型颅脑损伤GCS评分6～8分患者早期脑氧代谢的研究

Cerebral oxygen metabolism early in patients with severe craniocerebral injury at GCS 6～8

目的研究重型颅脑损伤格拉斯哥昏迷评分(GCS)评分6～8分患者急性期脑氧代谢的变化情况,并探讨其可能的发生机理。方法采集2009年6月—2011年7月35例术后转入ICU的重型颅脑损伤GCS评分6～8分患者的颈静脉血与桡动脉血,进行血气分析及血葡萄糖测定检查,计算脑氧利用率(O2Ucc)和颈内静脉与动脉血二氧化碳分压差(V-APCO2)、乳酸差(V-ALac)、血糖差(V-AGlu)的绝对值以及颈内静脉氧饱和度(SjvO2),根据短期预后将上述病例分为存活组和死亡组,并观察上述两组指标差异。结果与死亡组比较,存活组V-AGlu、V-ALac显著降低(P<0.05),O2Ucc、V-APCO2、SjvO2明显升高(P<0.05)。结论重型颅脑损伤GCS评分6～8分患者术后脑氧代谢在死亡组显示明显异常,尤其是无氧代谢增加显著。

Objective To study cerebral oxygen metabolism early in patients with severe craniocerebral injury at GCS between 6 and 8, and to explore the possible mechanism. Methods Thirty-five postoperative cases were selected from June 2009 to July 2011, who were in ICU with severe craniocerebral injury at GCS between 6 and 8, and blood was drawn from jugular vein and radial artery immediately for blood gas analysis and blood sugar monitoring. We calculated cerebral oxygen Utilization coefficients （ 02 Ucc）, differences of CO2 partial pressure （V-APCO2 ）, difference value of lactic acid （V-ALac）, absolute difference value of blood sugar （V-AGlu） and O2 suturation of jugular venous blood （ SjvO2 ）. 35 cases were divided into the death group and the living group according to short term prognosis, and the index difference of the two groups above were observed. Results Compared with the death group, V-Aglu, V-ALac significantly reduced in the living group （P 〈 0. 05 ）, which 02 Ucc, V-APCO2, SjvO2 increased significantly in the living group （P 〈 0. 05 ）. Conclusion The changes of cerebral oxygen metabolism in the acute phase in patients with severe craniocerebral injury at GCS 6 -8 show obvious abnormity, especially in significant increase of anaerobic metabolism.