颈静脉球血氧饱和度监测在重度颅脑损伤治疗中的应用研究

Application of jugular bulb oxygen saturation in the treatment of severe traumatic brain injury

目的探讨颈静脉球血氧饱和度(SjvO2)监测在重度颅脑损伤(sTBI)患者治疗中的应用效果。方法选择2016年8月至2017年8月上海健康医学院附属周浦医院收治的sTBI患者53例纳入研究,通过抽签法随机分为颅内压(ICP)监测向导组28例(ICP组)与SjvO2监测向导的治疗组25例(SjvO2组)。ICP组按常规方案进行治疗,SjvO:组除常规治疗方案外,动态监测SjvO2,通过调整治疗方案,使SjvO2维持在55%-75%的目标范围比较两组患者早期格拉斯哥昏迷评分(GCS评分)、伤后3个月格拉斯哥预后评分(GOS评分)以及病死率。结果SjvO2组伤后3 d内累计共有36%(9/25)患者出现SjvO2<55%事件;伤后第4天SjvO?组患者GCS评分较ICP组改善更明显[(7.17±1.41)分比(6.91 ±1.10)分,2 = 1.78,P = 0.03];伤后90 d两组患者病死率差异无统计学意义(P=0. 80);SjvO2组与ICP相比有更好的GOS良好预后率(24. 00%比10.70%,χ^2 =2. 31,P =0.05)。结论以SjvO2监测为向导的治疗策略可改善sTBI患者早期的意识水平,并能改善sTBI患者整体预后。

Objective To investigate the application of jugular bulb oxygen saturation (SjvO2) in the treatment of patients with severe traumatic brain injury ( sTBI). Methods From August 2016 to August 2017 ,fifty - three patients with sTBI admitted to intensive care unit ( ICU ) of Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences were randomly divided into the intracranial pressure - guided treatment group ( ICP group) and the SjvO2 - guided treatment group ( SjvO2 group) by draw lots method. The patients in ICP group ( n = 25 ) were treated according to the routine regimen,and the SjvO2 group ( n =28) was dynamically detected SjvO2, and the SjvO2 was maintained at the target range of 55%- 75% by adjusting the treatment scheme in addition to the routine treatment regimen. The early GCS score, GOS score and the mortality rate were compared between the two groups three months after injury. Results A total of 36%( 9/25 ) patients had SjvO2 < 55% events within 3 days after injury. On the fourth day after injury, the GCS score in the SjvO2 group was better than that in the ICP group [(7. 17 ± 1.41) points vs.(6. 91 ± 1. 10)points,t 1.78 p=0.03 ].and there was no statistically significant difference in mortality between the two groups at 90 days after injun-( P = 0. 80). The SjvO2 group had a better prognosis rate compared with ICP group(24.00% vs. 10. 70%,χ^2=2.31 p=0.05). Conclusion The treatment strategy of sTBI patients guided bv SjvO2 can improve early consciousness level and improve the overall prognosis of sTB1 patients.