严重脑创伤患者术后颅内压与高碳酸血症的关系

Association between postoperative intracranial pressure and hypercapnia in brain trauma

目的探讨脑创伤患者术后颅内压（ICP）与高碳酸血症的关系。方法 收集2013年1月~2015年10月榆林市中医医院收治的脑创伤患者100例,根据术后24 h ICP水平将患者分为高ICP组（70例）和正常ICP组（30例）。主要观察指标为术后不同时间点碳酸氢根和二氧化碳分压。结果 与正常ICP组比较,高ICP组患者术后24 h碳酸氢根显著增高[（24.53±5.75）比（32.51±4.98）mmol/L,P〈0.01],二氧化碳分压显著升高[（36.40±8.54）比（47.90±10.82）mm Hg,P〈0.01]（1 mm Hg=0.133 k Pa）。经积极改善通气等治疗后,高ICP组术后48 h ICP较术后24 h显著下降[（2.99±0.56）比（2.58±0.57）k Pa,P〈0.01];术后48 h碳酸氢根[（26.94±4.86）mmol/L]较术后24 h显著降低（P〈0.01）;术后48 h二氧化碳分压[（39.93±10.32）mm Hg]较术后24 h显著下降（P〈0.01）。术后24 h碳酸氢根在预测患者术后颅内高压的曲线下面积高达0.837（95%CI：0.756~0.919）。结论 严重脑创伤患者术后ICP水平和高碳酸血症具有良好的相关性。

Objective To investigate the association between postoperative intracranial pressure （ICP） and hypercapnia in patients with brain trauma. Methods One hundred patients with brain trauma from January 2013 to October 2015 in Chinese Medicine Hospital of Yulin City were collected and divided into intracranial hypertension group （70 cases） and normal intracranial group （30 cases） according to the 24 h postoperative ICP. The partial pressure of carbon dioxide and bicarbonate at different time points were observed. Results Bicarbonate of the intracranial hypertension group 24 h after operation was greatly improved compared with the normal intracranial group [（24.53±5.75） vs （32.51±4.98） mmol/L, P 〈 0.01]; partial pressure of carbon dioxide of the intraeranial hypertension group was greatly improved compared with the normal intraeranial group [（36.40±8.54） vs （47.90±10.82） mmHg, P 〈 0.01] （1 mmHg = 0.133 kPa）. After actively improving ventilation and other treatment, ICP of the intracranial hypertension group 48 h after operation was signifi- cantly decreased compared with the 24 h after operation [（2.99±0.56） vs （2.58±0.57） kPa, P 〈 0.01]. Bicarbonate of the intraeranial hypertension group 48 h after operation [26.94±4.86） retool/L] was significantly decreased compared with the 24 h after operation （P 〈 0.01）; partial pressure of carbon dioxide of the intraeranial hypertension group 48 h after operation [（39.93±10.32） mmHg] was significantly decreased compared with the 24 h after operation （P 〈 0.01）. The area under the curve of the bicarbonate after 24 h operation predicting intracranial hypertension was 0.837 （95% CI： 0.756-0.919）. Conclusion Postoperative ICP level, has good.correlation with hypercapnia in severe traumatic brain injury.