纯氧提高重度颅脑损伤患者颈静脉球血氧饱和度有效性的影响因素分析

Analysis of factors influencing the effectiveness of pure oxygen therapy for improving jugular bulb venous oxygen saturation in patients with severe traumatic brain injury

目的:探讨影响纯氧氧疗提高颈静脉球血氧饱和度(jugular bulb venous oxygen saturation,SjvO_2)有效性的相关因素。方法:纳入2016年8月至2018年4月入住上海健康医学院附属周浦医院重症监护病房(intensive care unit, ICU)行机械通气治疗、SjvO_2<55%的患者26例,年龄24～65(48.96±13.21)岁,格拉斯哥昏迷评分(Glasgow coma scale, GCS) 4～8(5.77±1.48)分。纯氧氧疗干预后1 h重新评价SjvO_2,根据SjvO_2对氧疗的有效反应性分为氧疗有效组(干预后SjvO_2≥55%)和无效组(干预后SjvO_2<55%)。分析患者性别、年龄、GCS、颅内压(intracranial pressure,ICP)、脑灌注压(cerebral perfusion pressure, CPP)、动脉血氧分压(arterial oxygen partial pressure, PaO_2)、乳酸(lactic acid, Lac)、呼气末二氧化碳分压(end-tidal carbon dioxide pressure,PETCO_2)、急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluatian, APACHEⅡ)以及合并基础肺疾病情况等因素对氧疗有效性的影响。结果:26例患者中,氧疗有效17例,无效9例;2组患者性别、CPP、Lac、PETCO2及APACHEⅡ等差异无统计学意义;与无效组比较,有效组患者年龄明显较小,GCS与PaO_2明显较高(均P<0.05);纯氧氧疗有效性与GCS[优势比(odds ratio, OR)=3.921,P=0.013,95%可信区间(confidence interval, CI):1.342～11.461)和PaO_2(OR=1.014,P=0.016,95%CI:1.003～1.025)呈正相关,与基础肺病变呈负相关(OR=0.038,P=0.003,95%CI:0.004～0.329)。结论 :基础GCS、基础肺疾病与氧疗后的PaO_2为影响纯氧氧疗提高SjvO_2有效性的因素。

Objective To analyze the factors influencing the effectiveness of pure oxygen therapy to improve the jugular bulb venous oxygen saturation(SjvO2). Methods From August 2016 to April 2018, 26 severe traumatic brain injury(sTBI) patients with SjvO2<55% admitted into intensive care unit(ICU) of Zhoupu Hospital and undergone mechanical ventilation were enrolled in this study. One hour after intervention with pure oxygen, SjvO2 was reassessed, and the effectiveness of pure oxygen therapy was defined as SjvO2≥55%. Those who failed in pure oxygen therapy were given further treatment including elevating cerebral perfusion pressure(CPP), deep analgesia and sedation, and mild hypothermia, et al.Statistical software SPSS 21.0 was used to analyze the effect of gender, age, Glasgow coma scale(GCS), intracranial pressure(ICP), cerebral perfusion pressure(CPP), arterial oxygen partial pressure(PaO2), lactic acid(Lac), end-tidal carbon dioxide pressure(PETCO2), acute physiology and chronic health evaluation(APACHE Ⅱ), and underlying lung diseases on the efficacy of pure oxygen therapy by binary Logistic regression analysis. Results Of the 26 patients, 17 were effective in pure oxygen therapy(SjvO2≥55%) and 9 were ineffective(SjvO2<55%). There were no differences in gender, CPP, Lac,PETCO2 and APACHE Ⅱ between the two groups. Compared with ineffective group, the effective group was significantly younger in age;GCS and PaO2 were significantly higher(all P<0.05). The efficacy of pure oxygen therapy was positively correlated with GCS and PaO2[odds ratio(OR)=3.921, P=0.013, 95% confidence interval(CI): 1.342-11.461;OR=1.014, P=0.016, 95% CI: 1.003-1.025], and negatively correlated with underlying lung diseases(OR =0.038, P =0.003, 95% CI:0.004-0.329). Conclusions Basic GCS, underlying lung diseases, and PaO2 after pure oxygen therapy are the factors that affect the effectiveness of pure oxygen therapy for SjvO2 improvement.