重度脑外伤后动态监测局部脑氧饱和度的临床意义

doi:10.3969/j.issn.1006-9771.2020.01.019

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (1): 106-109.doi: 10.3969/j.issn.1006-9771.2020.01.019

重度脑外伤后动态监测局部脑氧饱和度的临床意义

卢维新,侯博儒,王登峰,王刚,白若冰,严贵忠,王栋,李瑞豪,薛鑫,任海军()

兰州大学第二医院神经外科,甘肃兰州市 730000

收稿日期:2019-09-23 修回日期:2019-11-04 出版日期:2020-01-25 发布日期:2020-02-07
通讯作者: 任海军 E-mail:ldeyrenhj@126.com
作者简介:卢维新(1988-),男,汉族,甘肃通渭县人,硕士研究生,医师,主要研究方向：重型脑外伤及脑血管病。|任海军(1963-),男,汉族,甘肃兰州市人,主任医师、教授,硕士研究生导师,主要研究方向：重型脑外伤、脑血管病、脊髓脊柱、神经肿瘤等。
基金资助:
兰州市城关区科技计划项目(2018SHFZ0062)

Application of Dynamic Monitoring of Regional Cerebral Oxygen Saturation for Severe Traumatic Brain Injury

LU Wei-xin,HOU Bo-ru,WANG Deng-feng,WANG Gang,BAI Ruo-bing,YAN Gui-zhong,WANG Dong,LI Rui-hao,XUE Xin,REN Hai-jun()

Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, Gansu 730000, China

Received:2019-09-23 Revised:2019-11-04 Published:2020-01-25 Online:2020-02-07
Contact: REN Hai-jun E-mail:ldeyrenhj@126.com
Supported by:
Lanzhou Chengguan District Science and Technology Plan(2018SHFZ0062)

摘要/Abstract

摘要：

目的探讨重度脑外伤(sTBI)后,动态监测局部脑氧饱和度(SctO₂)的临床意义。
方法 2017年12月至2019年1月,sTBI后24 h内患者33例,采用近红外光谱技术每6小时监测SctO₂、颅内压(ICP)和脑灌注压(CPP),共7 d,记录入院时格拉斯哥昏迷评分(GCS)和伤后6个月格拉斯哥预后评分(GOS)。
结果 SctO₂于监测第3天最低,随后逐渐升高;SctO₂与ICP呈负相关(r < -0.857, P < 0.001),与GCS、CPP、GOS呈正相关( r > 0.697, P < 0.001)。
结论 sTBI后SctO₂监测可早期识别部分继发性损伤,判断疾病严重程度,并部分预测疾病结局。

关键词: 脑外伤, 近红外光谱技术, 局部血氧饱和度, 颅内压, 脑灌注压, 昏迷

Abstract:

Objective To investigate the value of clinical monitoring of regional cerebral oxygen saturation (SctO₂) for severe traumatic brain injury (sTBI).
Methods From December, 2017 to January, 2019, 33 patients with sTBI within 24 hours were monitored SctO₂, intracranial pressure (ICP) and cerebral perfusion pressure (CPP) with near-infrared spectroscopyonce per six hours for seven days. They were assessed with Glasgow Coma Score (GCS) at admission and Glasgow Outcome Score (GOS) six months after injury.
Results SctO₂ was the lowest on the third day of monitoring, and then increased gradually. SctO₂ negatevely correlated with ICP (r < -0.857, P < 0.001), and positively correlated with GCS, CPP and GOS ( r > 0.697, P < 0.05).
Conclusion SctO₂ monitoring is valuable after sTBI to identify the secondary injuries and severity of injuries, and predict the outcome partly.

Key words: traumatic brain injury, near-infrared spectroscopy, regional cerebral oxygen saturation, intracranial pressure, cerebral perfusion pressure, coma

中图分类号:

R651.1

卢维新,侯博儒,王登峰,王刚,白若冰,严贵忠,王栋,李瑞豪,薛鑫,任海军. 重度脑外伤后动态监测局部脑氧饱和度的临床意义[J]. 《中国康复理论与实践》, 2020, 26(1): 106-109.

LU Wei-xin,HOU Bo-ru,WANG Deng-feng,WANG Gang,BAI Ruo-bing,YAN Gui-zhong,WANG Dong,LI Rui-hao,XUE Xin,REN Hai-jun. Application of Dynamic Monitoring of Regional Cerebral Oxygen Saturation for Severe Traumatic Brain Injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(1): 106-109.

图/表 3

参考文献 34

[1]	Jiang J Y, Gao G Y, Feng J F, et al. Traumatic brain injury in China[J]. Lancet Neurol, 2019, 18(3):286-295. doi: S1474-4422(18)30469-1 pmid: 30784557
[2]	Murray C J, Lopez A D. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study[J]. Lancet, 1997, 349(9064):1498-1504. pmid: 9167458
[3]	Liao C C, Chou Y C, Yeh C C, et al. Stroke risk and outcomes in patients with traumatic brain injury: 2 nationwide studies[J]. Mayo Clin Proc, 2014, 89(2):163-172. doi: 10.1016/j.mayocp.2013.09.019
[4]	Langlois J A, Rutland-Brown W, Wald M M. The epidemiology and impact of traumatic brain injury: a brief overview[J]. J Head Trauma Rehabil, 2006, 21(5):375-378. doi: 10.1097/00001199-200609000-00001
[5]	Stein S C, Georgoff P, Meghan S, et al. 150 years of treating severe traumatic brain injury: a systematic review of progress in mortality[J]. J Neurotrauma, 2010, 27(7):1343-1353. doi: 10.1089/neu.2009.1206
[6]	Gupta M K, Mondkar J A, Hegde D. Paradoxical reaction to midazolam in preterm neonates: a case series[J]. Indian J Crit Care Med, 2018, 22(4):300-302. doi: 10.4103/ijccm.IJCCM_36_17
[7]	Dey S, Kumar M. Comparison of pretreatment with dexmedetomidine with midazolam for prevention of etomidate-induced myoclonus and attenuation of stress response at intubation: a randomized controlled study[J]. J Anaesthesiol Clin Pharmacol, 2018, 34(1):94-98.
[8]	Buunk G, vander Hoeven J G, Meinders A E. Cerebrovascular reactivity in comatose patients resuscitated from a cardiac arrest[J]. Stroke, 1997, 28(8):1569-1573. pmid: 9259750
[9]	Murkin J M, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation[J]. Br J Anaesth, 2009, 103(Suppl 1):i3-i13. doi: 10.1093/bja/aep299
[10]	Obrig H. NIRS in clinical neurology: a 'promising' tool?[J]. NeuroImage, 2014, 85(Pt 1):535-546. doi: 10.1016/j.neuroimage.2013.03.045
[11]	Green D W, Kunst G. Cerebral oximetry and its role in adult cardiac, non-cardiac surgery and resuscitation from cardiac arrest[J]. Anaesthesia, 2017, 72(Suppl 1):48-57. doi: 10.1111/anae.13740
[12]	Needham E, McFadyen C, Newcombe V, et al. Cerebral perfusion pressure targets individualized to pressure-reactivity index in moderate to severe traumatic brain injury: a systematic review[J]. J Neurotrauma, 2017, 34(5):963-970. doi: 10.1089/neu.2016.4450
[13]	Davie S N, Grocott H P. Impact of extracranial contamination on regional cerebral oxygen saturation: a comparison of three cerebral oximetry technologies[J]. Anesthesiology, 2012, 116(4):834-840. doi: 10.1097/ALN.0b013e31824c00d7
[14]	Le Roux P, Menon D K, Citerio G, et al. The International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: a list of recommendations and additional conclusions: a statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine[J]. Neurocritical Care, 2014, 21(Suppl 2):S282-S296.
[15]	Moerman A, De Hert S. Cerebral oximetry: the standard monitor of the future?[J]. Curr Opin Anaesthesiol, 2015, 28(6):703-709. doi: 10.1097/ACO.0000000000000256
[16]	Schnaubelt S, Sulzgruber P, Menger J, et al. Regional cerebral oxygen saturation during cardiopulmonary resuscitation as a predictor of return of spontaneous circulation and favourable neurological outcome - A review of the current literature[J]. Resuscitation, 2018, 125:39-47. doi: S0300-9572(18)30028-5 pmid: 29410191
[17]	Ahn A, Yang J, Inigo-Santiago L, et al. A feasibility study of cerebral oximetry monitoring during the post-resuscitation period in comatose patients following cardiac arrest[J]. Resuscitation, 2014, 85(4):522-526. doi: 10.1016/j.resuscitation.2013.12.007
[18]	Storm C, Leithner C, Krannich A, et al. Regional cerebral oxygen saturation after cardiac arrest in 60 patients–a prospective outcome study[J]. Resuscitation, 2014, 85(8):1037-1041. doi: 10.1016/j.resuscitation.2014.04.021 pmid: 24795284
[19]	Stenberg M, Koskinen L D, Jonasson P, et al. Computed tomography and clinical outcome in patients with severe traumatic brain injury[J]. Brain Inj, 2017, 31(3):351-358. doi: 10.1080/02699052.2016.1261303
[20]	Carney N, Totten A M, O'Reilly C, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition[J]. Neurosurgery, 2017, 80(1):6-15. doi: 10.1227/NEU.0000000000001432 pmid: 27654000
[21]	Sinha S, Hudgins E, Schuster J, et al. Unraveling the complexities of invasive multimodality neuromonitoring[J]. Neurosurg Focus, 2017, 43(5):E4.
[22]	Harary M, Dolmans R G F, Gormley W B. Intracranial pressure monitoring–review and avenues for development[J]. Sensors (Basel), 18(2):465. doi: 10.3390/s18020465
[23]	Ziegler D, Cravens G, Poche G, et al. Use of transcranial Doppler in patients with severe traumatic brain injuries[J]. J Neurotrauma, 2017, 34(1):121-127. doi: 10.1089/neu.2015.3967
[24]	He J, Chen J, Wu T, et al. The value of managing severe traumatic brain injury during the perioperative period using intracranial pressure monitoring[J]. J Craniofac Surg, 2019, 30(7):2217-2223.
[25]	Davies D J, Clancy M, Dehghani H, et al. Cerebral oxygenation in traumatic brain injury: can a non-invasive frequency domain near-infrared spectroscopy device detect changes in brain tissue oxygen tension as well as the established invasive monitor?[J]. J Neurotrauma, 2019, 36(7):1175-1183. doi: 10.1089/neu.2018.5667
[26]	Gan Z S, Stein S C, Swanson R, et al. Blood biomarkers for traumatic brain injury: a quantitative assessment of diagnostic and prognostic accuracy[J]. Front Neurol, 2019, 10:446. doi: 10.3389/fneur.2019.00446
[27]	Roh D, Park S. Brain multimodality monitoring: updated perspectives[J]. Curr Neurol Neurosci Rep, 2016, 16(6):56. doi: 10.1007/s11910-016-0659-0
[28]	Belli A, Sen J, Petzold A, et al. Metabolic failure precedes intracranial pressure rises in traumatic brain injury: a microdialysis study[J]. Acta Neurochir (Wien), 2008, 150(5):461-470. doi: 10.1007/s00701-008-1580-3 pmid: 18421408
[29]	Wood M D, Jacobson J A, Maslove D M, et al. The physiological determinants of near-infrared spectroscopy-derived regional cerebral oxygenation in critically ill adults[J]. Intensive Care Med Exp, 2019, 7(1):23. doi: 10.1186/s40635-019-0247-0
[30]	Lingsma H F, Roozenbeek B, Steyerberg E W, et al. Early prognosis in traumatic brain injury: from prophecies to predictions[J]. Lancet Neurol, 2010, 9(5):543-554. doi: 10.1016/S1474-4422(10)70065-X pmid: 20398861
[31]	Vilke A, Bilskiene D, Saferis V, et al. Predictive value of early near-infrared spectroscopy monitoring of patients with traumatic brain injury[J]. Medicina (Kaunas, Lithuania), 2014, 50(5):263-268.
[32]	Highton D, Ghosh A, Tachtsidis I, et al. Monitoring cerebral autoregulation after brain injury: multimodal assessment of cerebral slow-wave oscillations using near-infrared spectroscopy[J]. Anesth Analg, 2015, 121(1):198-205. doi: 10.1213/ANE.0000000000000790 pmid: 25993387
[33]	Padhy S K, Ajayan N, Hrishi A P, et al. Novel application of near-infrared spectroscopy in detecting iatrogenic vasospasm during interventional neuroradiological procedures[J]. Brain Circ, 2019, 5(2):90-93. doi: 10.4103/bc.bc_12_19
[34]	Chan M J, Chung T, Glassford N J, et al. Near-infrared spectroscopy in adult cardiac surgery patients: a systematic review and meta-analysis[J]. J Cardiothorac Vasc Anesth, 2017, 31(4):1155-1165. doi: 10.1053/j.jvca.2017.02.187

项目	统计值
性别(男/女, n)	22/11
年龄(岁)	39.48±11.93
受伤类型(n)
硬膜外血肿	5
硬膜下血肿	9
脑挫伤	13
弥漫性轴索损伤	6
伤后到入院时间(h)	11.12±3.92
手术/非手术(n)	24/9
入院时GCS	6.12±1.76
伤后6个月GOS	3.06±1.32

侧别	n	第1天	第2天	第3天	第4天	第5天	第6天	第7天
主要损伤侧	33	60.70±4.10	60.39±3.82	59.45±3.95	59.79±4.97	60.15±5.09	60.70±4.48	61.97±4.94
损伤对侧	33	66.58±4.72	64.76±5.03	63.91±5.28	65.00±5.65	65.67±6.19	65.76±5.95	67.15±6.72
t值		-14.76	-9.79	-7.42	-8.67	-7.93	-6.74	-8.99
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

重度脑外伤后动态监测局部脑氧饱和度的临床意义

Application of Dynamic Monitoring of Regional Cerebral Oxygen Saturation for Severe Traumatic Brain Injury

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