重型颅脑伤患者颈静脉血氧饱和度的监测及其临床意义

目的：探讨重型颅脑创伤后颈静脉血氧饱和度（ＳｊＯ２）的变化以及临床意义。方法：重型颅脑创伤患者３３例，格拉斯哥昏迷评分（ＧＣＳ）平均５．４６分，入院后经皮穿刺颈内静脉留置导管，监测ＳｊＯ２，同时监测颅内压（ＩＣＰ）、动脉氧饱和度（ＳａＯ２）、脉搏氧饱和度（ＳｐＯ２）以及颈静脉、动脉血气水平，每８小时测１次，监测１～７天。结果：３３例患者中有２５例出现脑氧不饱和状态，其中脑充血１９例，脑缺氧６例。创伤程度和颅内压影响ＳｊＯ２，并密切相关（创伤程度：ｒ＝－０．８７７，Ｐ＜０．００１；颅内压：ｒ＝０．４６８，Ｐ＜０．００１）。结论：严重颅脑创伤后，脑充血（脑过度灌注）较为常见，并与颅内压密切相关；ＳｊＯ２增高提示脑过度灌注。重型颅脑伤后若ＳｊＯ２持续０．５０或＞０．７０都表明预后不良。

Monitoring of jugular venous oxygen saturation after severe brain injury and its significance/

Objective:To investigate the changes in jugular venous oxygen saturation(SjO 2) and its clinical significance after severe brain injury.Methods:33 patients admitted to the hospital(average Glasgow coma scal score 5 46)after severe brain injury had continuous and simultaneous monitoring of SjO 2,intracranial pressure(ICP),SaO 2,SpO 2 and arterial and jugular venous blood gas levels were measured every eight hours for one to seven days.Results:There were 25 patients episodes of desaturation in these 33 patients:cerebral hyperemia in 19 patients and ischemia in six patients.The results showed that traumatic degree and ICP affected SjO 2.The SjO 2 correlated significantly with injury degree ( r =-0 877, P <0 001) and ICP( r =0 468, P <0 001).Conclusions:These data suggested that in patients with severe brain injury,cerebral hyperemia(cerebral luxury perfusion)was common and related to high ICP.The high value of ICP may indicated the cerebral luxury perfusion.