本文關(guān)鍵詞： 近紅外光譜 無創(chuàng)監(jiān)測 腦局部氧飽和度 重型顱腦損傷 顱內(nèi)壓　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的通過近紅外光譜技術(shù)實時無創(chuàng)監(jiān)測重型顱腦損傷術(shù)后局部腦氧飽和度,探討局部腦氧飽和度的變化規(guī)律以及與顱內(nèi)壓(ICP)之間的相關(guān)性。方法選擇自2015年7月至2016年11月安徽醫(yī)科大學(xué)附屬安慶醫(yī)院24例重度顱腦損傷急診術(shù)后患者,采用近紅外光譜與有創(chuàng)顱內(nèi)壓監(jiān)測儀持續(xù)監(jiān)測局部腦氧飽和度(rScO_2)、顱內(nèi)壓(ICP),同時使用多參數(shù)心電監(jiān)護(hù)儀監(jiān)測記錄脈氧飽和度(Sp O_2)、平均動脈壓(MAP)、腦灌注壓(CPP),采用SPSS統(tǒng)計學(xué)分析監(jiān)測結(jié)果的關(guān)聯(lián)性。結(jié)果重度顱腦損傷預(yù)后程度和rScO_2有統(tǒng)計學(xué)意義,預(yù)后越好的組其rScO_2值越高,術(shù)后rScO_2早期會出現(xiàn)下降,最后隨顱內(nèi)高壓緩解后再次呈上升趨勢。但4例死亡患者傷rScO_2主要呈下降趨勢,上升不明顯。rScO_2與ICP呈顯著負(fù)相關(guān)(r=-0.882,P0.001),rScO_2與CPP呈顯著正相關(guān)(r=0.938,P0.001)。MAP與rScO_2、ICP、CPP的線性相關(guān)無統(tǒng)計學(xué)意義(P0.05),P值分別為0.173、0.135、0.171。在重型顱腦損傷患者治療過程中,MAP、Sp O_2基本維持在正常范圍內(nèi),只有在患者處于瀕死狀態(tài)時進(jìn)行性降低。結(jié)論盡管目前臨床上顱內(nèi)監(jiān)測方法以有創(chuàng)顱內(nèi)壓監(jiān)護(hù)為主,但其價格昂貴,有導(dǎo)致顱內(nèi)感染、出血甚至死亡的危險。而近紅外光譜技術(shù)具有無創(chuàng)、方便及精確等特點(diǎn),可以準(zhǔn)確無創(chuàng)監(jiān)測腦組織局部腦氧飽和度,rScO_2對缺氧特別敏感,能及時反映重度顱腦損傷術(shù)后腦缺血缺氧等代謝情況,可以作為一種判斷重型顱腦損傷病情變化的指標(biāo)。通過近紅外光譜技術(shù)了解腦內(nèi)氧代謝水平,對于重型顱腦損傷治療及預(yù)后評估有著重要意義。
[Abstract]:Objective by near infrared spectroscopy in real time without invasive monitoring of regional cerebral oxygen saturation after severe head injury, to investigate the changes of regional cerebral oxygen saturation and intracranial pressure (ICP). The correlation between the methods from July 2015 to November 2016 in Anqing Hospital Affiliated to Medical University Of Anhui emergency surgery for 24 patients with severe craniocerebral injury, and using near infrared spectroscopy intracranial pressure monitor continuous monitoring of regional cerebral oxygen saturation (rScO_2), intracranial pressure (ICP), while the use of multi parameter ECG monitoring and recording pulse oxygen saturation (Sp O_2), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), using SPSS statistical correlation analysis of the monitoring results. The results of severe craniocerebral injury degree and prognosis of rScO_2 was statistically significant, the better the prognosis of group rScO_2 was higher, postoperative early rScO_2 will decline, and finally with the high pressure relief after intracranial again increased. Potential. But 4 cases of death in patients with rScO_2 injury mainly decreased, no significant increase of.RScO_2 was negatively correlated with ICP (r=-0.882, P0.001), rScO_2 had significant positive correlation with CPP (r=0.938, P0.001).MAP and rScO_2, ICP, CPP linear correlation was not statistically significant (P0.05), P = 0.173,0.135,0.171. in severe craniocerebral injury patients during the treatment, MAP, Sp and O_2 maintained in the normal range, only decreased in patients in dying state. Conclusion although the monitoring method of intracranial intracranial pressure in clinical care, but the price is expensive, due to intracranial infection, bleeding and even death in danger. Infrared spectroscopy is a non-invasive, convenient and accurate, can accurate noninvasive monitoring of regional cerebral oxygen saturation in brain tissue, rScO_2 is particularly sensitive to hypoxia, it can reflect the severe craniocerebral injury postoperative cerebral ischemia and hypoxia and metabolic. It can be used as an index for judging the severity of severe craniocerebral injury. It is important to understand the level of oxygen metabolism in the brain by NIR spectroscopy, which is of great significance for the treatment and prognosis of severe traumatic brain injury.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.15

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