Vigué B, Ract C, Benayed M, Zlotine N, Leblanc P E, Samii K, Bissonnette B
Département d'Anesthésiologie, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France. darkb@.imaginet.fr
Intensive Care Med. 1999 May;25(5):445-51. doi: 10.1007/s001340050878.
To investigate early cerebral variables after minimal resuscitation and to compare the adequacy of a cerebral perfusion pressure (CPP) guideline above 70 mmHg, with jugular bulb venous oxygen saturation (SjvO2) monitoring in a patient with traumatic brain injury (TBI).
Prospective, observational study.
Anesthesiological intensive care unit.
27 TBI patients with a postresuscitation Glasgow Coma Scale score less than 8.
After initial resuscitation, cerebral monitoring was performed and CPP increased to 70 mmHg by an increase in mean arterial pressure (MAP) with volume expansion and vasopressors as needed.
MAP, intracranial pressure (ICP), CPP, and simultaneous arterial and venous blood gases were measured at baseline and after treatment. Before treatment, 37% of patients had an SjvO2 below 55%, and SjvO2 was significantly correlated with CPP (r = 0.73, p < 0.0001). After treatment, we observed a significant increase (p < 0.0001) in CPP (78+/-10 vs 53+/-15 mmHg), MAP (103+/-10 vs 79+/-9 mmHg) and SvjO2 (72+/-7 vs 56+/-12), without a significant change in ICP (25+/-14 vs 25+/-11 mmHg).
The present study shows that early cerebral monitoring with SjvO2 is critical to assess cerebral ischemic risk and that MAP monitoring alone is not sensitive enough to determine the state of oxygenation of the brain. SjvO2 monitoring permits the early identification of patients with low CPP and high risk of cerebral ischemia. In emergency situations it can be used alone when ICP monitoring is contraindicated or not readily available. However, ICP monitoring gives complementary information necessary to adapt treatment.
研究轻度复苏后脑早期变量，并比较创伤性脑损伤（TBI）患者中脑灌注压（CPP）高于70 mmHg的指南的充分性与颈静脉球血氧饱和度（SjvO2）监测情况。
前瞻性观察性研究。
麻醉重症监护病房。
27例复苏后格拉斯哥昏迷量表评分低于8分的TBI患者。
初始复苏后，进行脑监测，并根据需要通过扩容和使用血管升压药提高平均动脉压（MAP），使CPP升至70 mmHg。
在基线和治疗后测量MAP、颅内压（ICP）、CPP以及同时测量动脉和静脉血气。治疗前，37%的患者SjvO2低于55%，且SjvO2与CPP显著相关（r = 0.73，p < 0.0001）。治疗后，我们观察到CPP（78±10 vs 53±15 mmHg）、MAP（103±10 vs 79±9 mmHg）和SvjO2（72±7 vs 56±12）显著升高（p < 0.0001），而ICP无显著变化（25±14 vs 25±11 mmHg）。
本研究表明，早期使用SjvO2进行脑监测对于评估脑缺血风险至关重要，仅MAP监测不足以敏感地确定脑氧合状态。SjvO2监测可早期识别CPP低且脑缺血风险高的患者。在紧急情况下，当ICP监测禁忌或难以进行时，可单独使用SjvO2监测。然而，ICP监测可提供调整治疗所需的补充信息。
