本文關(guān)鍵詞： 重型顱腦損傷 動靜脈乳酸差值 頸內(nèi)靜脈氧飽和度 腦灌注壓 預(yù)后　出處：《復(fù)旦大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：重型顱腦損傷常伴有早期腦灌注不足。通過動態(tài)監(jiān)測重型顱腦損傷患者的動靜脈乳酸差值(arteriojugular venous lactate difference, AVDL)和頸靜脈血氧飽和度(jugular blood oxygen saturation,SjvO2),希望發(fā)現(xiàn)：1)傷后早期是否存在SjvO2和AVDL的異常；2)異常的SjvO2和AVDL與預(yù)后的關(guān)系；3)低灌注是早期腦缺血的最常見病因,低灌注的標準及SjvO2和AVDL與腦灌注壓(cerebral perfusion pressure, CPP)水平是否存在相關(guān)性。方法：35例重型顱腦損傷病人傷后3天內(nèi)每6小時抽取股動脈和頸靜脈球血樣本,監(jiān)測平均動脈壓(mean arterial pressure, MAP)、顱內(nèi)壓(intracranial pressure, ICP)、SjvO2、乳酸值,計算AVDL、 CPP。本研究分為重型顱腦損傷組(GCS 3—8分)和對照組(無顱腦損傷,麻醉延遲復(fù)蘇),重型顱腦損傷組根據(jù)隨訪半年后GOS評分,分為預(yù)后良好組和預(yù)后不良組。統(tǒng)計分析各組間SjvO2和AVDL的差異,同時分析SjvO2和AVDL等指標與CPP水平的相關(guān)性。結(jié)果：采集478例血樣本,測定重型顱腦損傷組SjvO2均值為0.549±0.086,對照組SjvO2均值為0.622±0.013,重型顱腦損傷組AVDL均值為-0.321±0.078mmol/L,對照組AVDL均值為-0.284±0.062 mmol/L。35例重型顱腦損傷病人AVDL、SjvO2異常值監(jiān)測發(fā)現(xiàn)Sjv02≥75%出現(xiàn)一次為3例(9%),多次2例(6%),SjvO2≤50%出現(xiàn)一次為5例(16%),多次6例(17%),出現(xiàn)病理性AVDL一次為5例(16%),多次5例(16%)。重型顱腦損傷患者中預(yù)后良好組監(jiān)測SjvO2在50%～75%之間者與出現(xiàn)SjvO2患者相比較,經(jīng)Fiser's確切概率法檢驗,前者預(yù)后好于后者,雙、單側(cè)精確概率均為0.042,有統(tǒng)計學(xué)意義。SjvO2 50%～75%者與SjvO2≤50%者相比較,前者預(yù)后好于后者,X2=6.903,P=0.009,有統(tǒng)計學(xué)意義。重型顱腦損傷患者中出現(xiàn)生理性AVDL的預(yù)后好于出現(xiàn)病理性AVDL,兩者相比較X2=5.303,P=0.021,有統(tǒng)計學(xué)意義。在CPP60mmHg時,經(jīng)檢驗SjvO2與CPP呈正相關(guān),相關(guān)系數(shù)r=0.743,p0.01。當CPP60mmHg時,經(jīng)檢驗AVDL與CPP呈負相關(guān),相關(guān)系數(shù)r=-0.379,p0.01。結(jié)論：重型顱腦損傷患者監(jiān)測發(fā)現(xiàn)SjvO2≤50%, SjvO2≥75%或病理性AVDL,預(yù)后欠佳。SjvO2和AVDL與重型顱腦損傷患者合并低灌注有明確的相關(guān)性,可作為病情監(jiān)測的有效指標。
[Abstract]:Objective: severe craniocerebral injury is often associated with early cerebral perfusion insufficiency. By dynamic monitoring of arteriovenous venous lactate difference (AVDL) and jugular blood oxygen saturation of jugular blood oxygen saturation (VO2) in patients with severe craniocerebral injury (CBI), we hope to find that the early stage after V1 was found to be. The relationship between abnormal SjvO2 and AVDL and prognosis. Low perfusion is the most common cause of early cerebral ischemia. There was no correlation between SjvO2 and AVDL and cerebral perfusion pressure (CPPs). Methods femoral and jugular globus blood samples were taken from 35 patients with severe craniocerebral injury every 6 hours in 3 days after injury. Mean arterial pressure.MAPP, intracranial pressure, intracranial pressure, ICPU SjvO2, lactic acid value, AVDL, CPP.This study was divided into severe craniocerebral injury group (GCS3-8 score) and control group (no craniocerebral injury, anaesthesia delayed resuscitation), severe craniocerebral injury group according to the GOS score after half a year follow-up. The difference of SjvO2 and AVDL was statistically analyzed, and the correlation between SjvO2, AVDL and CPP level was analyzed. Results: 478 blood samples were collected. The mean value of SjvO2 was 0.549 鹵0.086 in severe craniocerebral injury group, 0.622 鹵0.013 in control group, -0.321 鹵0.078 mmol / L in severe craniocerebral injury group, and -0.284 鹵0.062 mmol/L.35 in control group. There were 5 cases with SjvO2 鈮，

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