摘要目的 分析亚低温治疗状态下对重型颅脑损伤(sTBI)患者进行脑多参数监测的结果,评估常规降颅压手段的临床意义.方法 42例sTBI患者(GCS＜8分)进行亚低温治疗.对42例患者随机分组,对其进行颅内压(ICP)、脑灌注压(CPP)、脑组织氧分压(PbtO2)和颈静脉血氧饱和度(SjvO2)等指标连续监测并进行比较分析.结果 (1)42例患者在亚低温治疗后CPP、PbtO2和SjvO2水平明显上升,ICP水平明显下降.(2)亚低温状态下,以两种剂量(25 g及50 g)甘露醇对ICP＞ 20 mm Hg者进行脱水治疗.治疗30 min后,两组患者ICP均有显著降低,90 min后,25 g组ICP反弹明显,而50 g组ICP仍稳定在较低水平.(3)亚低温状态下,随着过度换气程度的不断增加,ICP降低的程度显著增加,但出现低PbtO2的比率也随之增高.(4)16例行去骨瓣减压术sTBI患者术后ICP明显下降,CPP、PbtO2及SjvO2均有不同程度增高.结论 亚低温状态下,对于颅脑创伤后ICP增高的处理,可供选择手段较多,在使用过程中,密切观察生命体征变化的同时,给予脑多参数监测,十分必要.

abstractsObjective To analyze and evaluatethe change and clinical significance of brain multiparameter monitoring in guiding the application of conventional intracranial pressure reducing means in the course of mild hypothermia treatment (MHT) of severe traumatic brain injury (sTBI).Methods There were 42 cases in the course of mild hypothermia treatment of severe traumatic brain injury (sTBI).Intracranial pressure (ICP),cerebral perfusion pressure (CPP),brain tissue partial pressure of oxygen (PbtO2),and jugularm venous oxygen saturation (SjvO2) were continuously monitored in 42 cases with sTBI for analyzing the correlations inside.Results 1.Increasing CPP,PbtO2,and SjvO2 were found after the course of MHT for 42 cases with sTBI,and the correlations between each index were closely insides.2.Dehydrating with mannitol in two doses (25 g and 50 g)on ICP ＞ 20 mm Hg,the ICP of two groups of patients were significandy reduced after 30 minutes of treatment.ICP of 25 g group rebounded significantly after 90 min; the 50 g group remained stable at a low level.3.As the degree of hyperventilation deepened,ICP reduction effects were more obvious and the proportion of low PbtO2 also increased.4.ICP decreased in 16 cases of severe brain injury patients after decompressive craniotomy surgery.Furthermore,CPP,PbtO2and SjvO2 increased in varying degrees.Conclusions Continuous monitoring of PbtO2,SjvO2,ICP,and CPP can reflect the close correlations between them.Closely monitoring each index can timely and accurately reflect intracranial condition changes,be used to guide therapy and is of great significance for prognosis.