中心静脉血氧饱和度及中心静脉-动脉二氧化碳氧分压差与重型颅脑损伤患者预后的关系

The association of central venous oxygen saturation and central venous-arterial carbon dioxide partial pressure with the prognosis of severe traumatic brain injury

目的分析中心静脉血氧饱和度(central venous oxygen saturation,ScvO2)与中心静脉-动脉二氧化碳氧分压差(central venous-to-arterial carbon dioxide difference,Pcv-aCO2)和重型颅脑损伤患者预后的关系。方法选取我科2011-01—2014-05收入ICU的重型颅脑损伤患者100例。按照ScvO2和Pcv-aCO2水平分为1、2、3、4组,对比4组患者治疗24h后的血清学指标、一般情况和外周动脉血气,对比4组临床结局。结果 1~4组治疗后24h的血清乳酸浓度、hs-CRP和S100B蛋白依次显著降低,而乳酸清除率依次显著增高(P<0.05)。1~4组治疗后24h的CVP、MAP和尿量依次显著升高,而APACHEⅡ评分依次显著降低(P<0.05)。1~4组治疗后24h的氧分压、pH值和BE值依次显著升高,而二氧化碳分压依次显著降低(P<0.05)。1~4组住ICU时间、出院时NIHSS评分和住院期间病死率依次降低(P<0.05)。结论 ScvO2联合Pcv-aCO2可有效预测重型颅脑损伤患者的预后,对其治疗有一定的指导意义。

Objective To analyze the relationships between central venous oxygen saturation(ScvO2)and central venousarterial carbon dioxide partial pressure(Pcv-aCO2)and the prognosis of severe traumatic brain injury.Methods One hundred patients with severe traumatic brain injury admitted to ICU of our department from January 2011 to May 2014 were recruited.According to the levels of ScvO2 and Pcv-aCO2,we divided all patients into four groups,in which serum markers,general situation,peripheral arterial blood gas and clinical outcome after 24-hour treatment were comparatively recorded and analyzed.Results The serum lactate concentration and the levels of hs-CRP and S100 Bproteins as well as APACHEII scores were significantly reduced in turn from group 1to group 4,while lactate clearance rate,CVP,MAP,PH value,BE value,oxygen partial pressure and urine volume were significantly decreased(P<0.05).Additionally,the hospitalization of stays,NIHSS scores when discharged,fatality rate of each group were also gradually reduced one by one.Conclusion ScvO2 combined with Pcv-aCO2 can effectively predict the prognosis of severe traumatic brain injury,which have certain guiding significance for treatment.