重型脑伤患者亚低温治疗后脑组织氧分压、二氧化碳分压和pH值的变化

Changes of brain tissue oxygen tension, carbon dioxide tension and pH value after mild hypothermia treatment in patients with severe brain injury

目的 探讨重型颅脑损伤患者亚低温 ( 3 3～ 3 5℃ )治疗后的脑组织氧分压 (PtiO2 )、二氧化碳分压 (PtiCO2 )和pH值的变化及其临床意义。 方法 重型脑伤患者 (GCS 3～ 8分 ) 4 1例 ,随机分为亚低温治疗组 2 1例 ,常温对照组 2 0例。动态监测伤后急性期脑组织PtiO2 、PtiCO2 和pH值 ,观察两组各个指标的变化及其与预后的关系。 结果 亚低温治疗 2 4h后 ,脑组织PtiO2 和pH值逐渐上升 ,PtiCO2 逐渐下降 ,并趋于正常 ,与对照组比较 ,差异有显著性意义 (P <0 .0 5 )。持续性PtiO2 <1.3 3kPa的患者死亡率明显高于PtiO2 ≥ 1.3 3kPa的患者 (P <0 .0 5 )。 结论 亚低温治疗能减轻脑伤患者的脑组织氧代谢紊乱 ,改善预后 ,且需尽早进行。脑组织PtiO2 、PtiCO2 和pH值动态监测技术安全可靠 ,对临床判断病情。

Objective WU Jiang, XU Jianmin, HUANG Zhenlin, et al. Department of Neurosurgery, Xixiang People's Hospital, Shenzhen 518102, China Abstract Objective To study the clinical effect of mild hypothermia on the brain tissue oxygen tension (PtiO 2), the brain tissue carbon dioxide tension (PtiCO 2) and pH value of the patients with severe brain injury. Methods A total of 41 patients with severe brain injury (3 ≤ GCS ≤ 8 on admission) were randomly divided into the hypothermia therapy group (n = 21) and the normothermia control group(n = 20). Mild hypothermia was employed within 24 hours after injury and lasted for 3-5 days until the rectal temperature reached at 33-35℃. The PtiO 2, PtiCO 2 and pH value in the acute period after injury were measured dynamically. And the relationship between the change of the indexes and the prognosis in the 2 groups was also studied. Results With mild hypothermia, the PtiO 2 and pH value increased and the PtiCO 2 decreased gradually. After 24 hours of hypothermic treatment, they returned to the normal levels. The PtiO 2 and pH value were higher and the PtiCO 2 was lower in hypothermia therapy group than that of the normothermia control group (P < 0.05 ). The mortality of the patients with PtiO 2 < 1.33 kPa was higher than the patients with PtiO 2 ≥ 1.33 kPa ( P < 0.05 ), whether mild hypothermia was used or not. Conclusions Mild hypothermia can alleviate the metabolic disorder of the brain tissue and improve the prognosis in the early stage of brain injury. The dynamic monitoring technique used for the PtiO 2, PtiCO 2 and pH value measurement is safe and reliable and has important significance for judging injury condition and instructing treatment in clinic.