重症颅脑损伤患者脑氧利用率的临床研究

Clinical study of cerebral oxygen utilization coefficients in patients with severe head injury

目的 探讨重症颅脑损伤患者脑氧利用率 (O2 U Cc)与病情及预后的关系和意义。方法 选择重症颅脑损伤 4 0例作为实验组 ,同期 4 0例轻、中度颅脑损伤作为对照组。通过颈内动脉和颈内静脉采血 ,观察颈内动脉血氧饱和度 (Sa O2 )、颈内静脉血氧饱和度 (Sj O2 )以及颈内动静脉血氧饱和度差〔 S(a j) O2 〕;根据氧利用率的计算公式推导出 O2 UCc。O2 U Cc=S(a j) O2 / Sa O2 ,并计算 O2 U Cc;分析 O2 U Cc与颅脑损伤病情及预后的关系。结果 实验组 Sa O2 与对照组比较无显著性差异 ;实验组 Sj O2 升高 ,O2 U Cc降低 ,与对照组比较差异显著 (P均 <0 .0 1)。实验组死亡 2 6例 ,存活 14例 ,病死率 6 5 %。死亡组 Sa O2 与存活组比较无显著性差异 ;死亡组 Sj O2 升高 ,O2 UCc降低 ,与存活组比较差异显著 (P均 <0 .0 1)。结论 重症颅脑损伤常伴有脑氧代谢动力学障碍 ,以高 Sj O2 和低 O2 U Cc为主要表现 ;O2 UCc<11%预示预后不良。

ObjectiveTo investigate the relationship in cerebral oxygen utilization coefficients(O_2UCc) in patients with acute severe head injury and illness prognosis. MethodsForty patients with acute severe head injury were studied,and 40 patients with light head injury were used as control. Through blood analysis,the changes in oxygen saturation of carotid blood(SaO_2),oxygen saturation of jugular blood(SjO_2),cerebral arteriovenous difference of oxygen saturation〔S(aj)O_2〕,O_2UCc were observed. Furthermore,the relationship of these patients' condition and prognosis was analyzed. ResultsThere was no significant change between the test group and control group in SaO_2. In test group,SjO_2 increased and O_2UCc decreased , there was an obvious difference between two groups(both P<0.01). In test group,26 died and 14 lived. There was no significant difference between died and lived patients in SaO_2. SjO_2 significantly increased and O_2UCc obviously decreased in died patients in comparison with those of the lived patients (both P<0.01) . ConclusionCerebral oxygen metabolism dynamics obstacle frequently was accompanied with acute severe head injury. The high SjO_2 and low O_2UCc are main symptoms with O_2UCc<11% hinting a bad prognosis.