脑组织氧代谢监测在心肺复苏后缺血缺氧性脑病患者中的临床研究

Clinical study of cerebral oxygen metabolism in patients with anoxic-ischemic encephalopathy after cardiopulmonary resuscitation

目的探讨颈内静脉球血氧饱和度、氧利用率、乳酸及乳酸清除率在早期心肺复苏后缺血缺氧性脑病患者中的变化及评价它们反映脑氧代谢改变中的意义。方法29个心肺复苏成功的患者，分为缺血缺氧性脑病（A组）和非缺血缺氧性脑病组（B组），比较复苏时间，颈内静脉球血氧饱和度、氧利用率、乳酸及乳酸清除率在心肺复苏后缺血缺氧性脑病和非缺血缺氧性脑病患者间的差别。结果①2组患者性别、年龄差异无统计学意义（P〉0．05）；②A组患者复苏时间长于B组（P〈0．05）；③2组患者在心肺复苏5min左右时SjVO2明显降低，O2UC、乳酸含量明显增高两者差异无统计学意义（P〉0．05）。B组患者SjVO2及O2UC约4h左右恢复正常，24h及72h持续稳定。与B组相比，A组患者在复苏后4h内SjVO2仍明显降低（P〈0．05），O2UC仍明显增高（P〈0．05），缺氧持续存在，24h、72h SjVO2恢复较高水平（P〈0．05），02UC持续降低（P〈0．05）。④B组心肺复苏后1～72h内乳酸含量进行性下降，各时间点相比于A组含量明显减低（P〈0．05），约24h恢复正常。A组乳酸72h内也呈下降趋势且72h内仍高于正常，4h乳酸清除率约为0．25±0．18，72h内乳酸清除率为0．61±0．15，明显低于B组的0．67±0．11及0．9l±0．62。结论心肺复苏时间及4h左右的脑颈静脉球血氧饱和度、乳酸及乳酸清除率、脑氧利用率在一定程度上能早期预测心肺复苏后患者缺血缺氧性脑病的发生。

Objective To observe the change of jugular venous bulb oxygen saturation（ SjVO2 ）, oxygen utilization coefficient （O2 UC ） ,lactic acid and blood lactate clearance rate in patients with anoxic-ischemic encephalopathy after cardiopulmonary resuscitation（CPR） and evaluate their significance in reflecting the changes of cerebral oxygen metabolism. Methods 29 patients with successful CPR were enrolled and divided into two groups：hypoxic ischemic encephalopathy（ group A） and non-hypoxic-ischemic encephalopathy（ group B）. The CPR time, SjVO2, oxygen utilization coefficient（O2UC） ,lac- tic acid and blood lactate clearance rate were detected and compared between the two groups. Results （1）There was no statistical difference in age and sex between the two groups（ P 〉 0.05 ）. （2）Duration of resuscitation efforts in group A was longer than that of group B （P 〈 0.05 ）. （3）5min after CPR, the levels of SjVO2 decreased, and 02 UC and lactic acid con- tent increased significantly in both groups, no significant difference was found （ P 〉 0.05 ）. In group B, the levels of SjVO2 and 02 UC return to normal in 4h, and kept stable levels in 24 hours and 72 hours. In group A, the levels of SjVO2 was still low and the levels of O2UC was still high in 4 hours （ P 〈 0.05 ）, persistent tissue hypoxia was continued. SjVO2 recovered to a higher levels in 24 and 72 hours （P 〈 0.05 ） , but the levels of O2UC dropped continually （P 〈 0.05 ）. （4）The levels of lactic acid in group B decreased progressively within 1 -72 h, and was lower at each time point as compared with those in group A（ P 〈 O. 05 ）. The level of lactic acid in group B returned to normal in 24 hours ,but still maintained a higher level in group A as compared to the normal level,through the downside trend was obviously. The 4 h ,72 h lactate clearance in B group was significantly higher than those in the group A,（0.25 ±0.18） vs. （0.67±0.11） and （0.61 ±0.15） vs. （0.91 ±0.62）, P 〈 0.05, respectively. Conclusion The duration of CPR, levels of SjVO2 and lactic acid, and lactate clearance and O2UC are good prognostic factor of patients with anoxic-ischemic encephalopathy in 4h after CPR.