Gupta A K, Hutchinson P J, Al-Rawi P, Gupta S, Swart M, Kirkpatrick P J, Menon D K, Datta A K
Department of Anesthesia, University of Cambridge, Addenbrooke's Hospital, United Kingdom.
Anesth Analg. 1999 Mar;88(3):549-53. doi: 10.1097/00000539-199903000-00016.
Jugular bulb oximetry is the most widely used method of monitoring cerebral oxygenation. More recently, measurement of brain tissue oxygenation has been reported in head-injured patients. We compared the changes in brain tissue oxygen partial pressure (PbO2) with changes in jugular venous oxygen saturation (SjVO2) in response to hyperventilation in areas of brain with and without focal pathology. Thirteen patients with severe head injuries were studied. A multiparameter sensor was inserted into areas of brain with focal pathology in five patients and outside areas of focal pathology in eight patients. A fiberoptic catheter was inserted into the right jugular bulb. Patients were hyperventilated in a stepwise manner from a PaCO2 of approximately 35 mm Hg to a PaCO2 of 22 mm Hg. There was no significant change in cerebral perfusion pressure or arterial partial pressure of oxygen with hyperventilation. In areas without focal pathology, there was a good correlation between changes in SjVO2 and PbO2 (deltaSjVO2 and deltaPbO2; r2 = 0.69, P < 0.0001). In areas with focal pathology, there was no correlation between deltaSjVO, and APbO2 (r2 =0.07, P = 0.23). In this study, we demonstrated that measurement of local tissue oxygenation can highlight focal differences in regional cerebral oxygenation that are disguised when measuring SjVO2. Thus, monitoring of PbO2 is a useful addition to multimodal monitoring of patients with traumatic head injury.
Brain oxygenation is currently monitored by using jugular bulb oximetry, which attracts a number of potential artifacts and may not reflect regional changes in oxygenation. We compared this method with measurement of brain tissue oxygenation using a multiparameter sensor inserted into brain tissue. The brain tissue monitor seemed to reflect regional brain oxygenation better than jugular bulb oximetry.
颈静脉球血氧饱和度测定是监测脑氧合最广泛使用的方法。最近，已有报道对头外伤患者进行脑组织氧合测量。我们比较了在有和没有局灶性病变的脑区，过度通气时脑组织氧分压（PbO2）的变化与颈静脉血氧饱和度（SjVO2）的变化。对13例重度颅脑损伤患者进行了研究。在5例患者的局灶性病变脑区和8例患者的局灶性病变以外脑区插入了多参数传感器。将光纤导管插入右颈静脉球。患者以逐步方式从约35mmHg的动脉血二氧化碳分压（PaCO2）过度通气至22mmHg的PaCO2。过度通气时脑灌注压或动脉血氧分压无显著变化。在没有局灶性病变的脑区，SjVO2变化与PbO2变化之间存在良好的相关性（ΔSjVO2与ΔPbO2；r2 = 0.69，P < 0.0001）。在有局灶性病变的脑区，ΔSjVO2与ΔPbO2之间无相关性（r2 = 0.07，P = 0.23）。在本研究中，我们证明局部组织氧合测量可以突出区域脑氧合的局灶性差异，而这些差异在测量SjVO2时被掩盖。因此，监测PbO2是对创伤性脑损伤患者进行多模式监测的有益补充。
目前通过颈静脉球血氧饱和度测定来监测脑氧合，这会产生许多潜在的假象，且可能无法反映氧合的区域变化。我们将这种方法与使用插入脑组织的多参数传感器测量脑组织氧合进行了比较。脑组织监测似乎比颈静脉球血氧饱和度测定能更好地反映区域脑氧合情况。
