脑组织氧分压与颅内压联合监测对重型颅脑损伤治疗的指导价值

Guiding value of brain tissue oxygenation plus intracranial pressure monitoring in severe traumatic brain injury patients

目的探讨脑组织氧分压联合颅内压监测对重型颅脑损伤治疗的指导意义，以提高脑氧为目标干预治疗的效果。方法本文为前瞻性研究，对江阴市人民医院神经外科2009年6月至2012年6月收治46例重型颅脑损伤患者，随机分成两组，每组23例，即：应用脑组织氧分压联合颅内压监测的患者（PbtO2组）与单独进行颅内压监测的患者（ICP组），两组患者的治疗目标维持颅内压〈20mmHg，脑灌注压≥60mmHg，对脑组织氧分压监测患者，将脑组织氧分压目标控制≥20mmHg，伤后6个月比较两组死亡率及格拉斯哥预后评分。结果两组平均每天的颅内压、脑灌注压水平相似的，ICP组死亡率21．7％（5例），预后良好47．8％（11例），而PbtO2组死亡率8．7％（2例），预后良好65．2％（15例），两组比较P〈0．05。结论脑组织氧分压联合颅内压监测并依据脑组织氧分压进行指导治疗能够显著降低重型颅脑损伤患者的死亡率，改善预后。

Objective To elucidate the effectiveness of brain tissue oxygenation （ PbtO2 ） plus intracranial pressure （ICP） monitoring and targeted therapy in patients of severe traumatic brain injury （TBI）. Methods A total of 46 patients with severe TBI（ Glasgow coma scale, GCS scale ≤ 8）admitted at Jiangyin People＇s Hospital from June 2009 to June 2012 were divided randomly into 2 groups and evaluated prospectively. Patients undergoing ICP plus PbtO2 monitoring were compared with controls with ICP monitoring alone. Therapies of both patient groups were attempted to maintain an ICP 〈 20 mm Hg and a cerebral peffusion pressure （CPP） ≥ 60 mm Hg. Among those with PbtO2 monitoring, oxygenation was maintained at a level of ≥20 mm Hg. The scores of Glasgow outcome scale （GOS） were compared between two groups at Month 6 post-injury. Results The mean daily ICP and CPP levels were similar in each group. The mortality rate was 21.7% in patients with ICP monitoring alone and the favorable outcome rate was 47. 8%. However, those receiving combined management had a significantly reduced mortality rate of 8.7 % and good outcome rate of 65.2% （ P 〈 0. 05 ）. Conclusion The combined use of both ICP and PbtO2 may be associated with reduced mortality and improved outcome in patients with severe TBI.