Department of Trauma/Critical Care, Medical University of South Carolina, GRMERC/MSU Surgical Critical Care Fellowship, Charleston, SC 29425, USA.
Clin Neurophysiol. 2012 Jun;123(6):1255-60. doi: 10.1016/j.clinph.2011.08.035. Epub 2011 Nov 21.
Utilization of brain tissue oxygenation (pBtO(2)) is an important but controversial variable in the treatment of traumatic brain injury (TBI). We evaluated the correlation between pBtO(2)/CPP and pBtO(2)/ICP and determined the parameter most closely related to survival.
Consecutive, adult patients with severe TBI and pBtO(2) monitors were retrospectively identified. Time-indexed measurements of pBtO(2), CPP and ICP were collected and correlation coefficients were determined. Patients were then stratified according to survival and pBtO(2), CPP and ICP values were compared between groups.
There were 4169 time-indexed data points (i.e., pBtO(2) with respective CPP and ICP values) in 15 patients. The cohort consisted of a mean age of 37±17 years, ISS of 27±7 and GCS of 4.5±1.5. Survival was 53% (8/15). In a normal regression models, neither the ICP (p=0.58) nor the CPP (p=0.71) predict pBtO(2) significantly. There was a significant difference in pBtO(2) in survivors (31.5±3.1 vs. 25.2±4.8, p=0.010) but not in CPP or ICP. Survivors had a lower proportion of time with pBtO(2)<25 mmHg [20% (3.4-44.6) vs. 40% (16.2-89), p=0.049]. In contrast, survivors had a greater proportion of time with CPP<70 and no difference in the proportion of time with and ICP>20.
CPP and ICP should not be used as surrogates for pBtO(2) since cerebral oxygenation varies independently of cerebral hemodynamics and pressures. Brain tissue oxygen monitoring in patients with TBI provides unique information regarding cerebral oxygenation the utility of which remains to be fully described.
CPP and ICP are not surrogates for pBtO(2). Brain tissue oxygenation monitoring provides unique information for the treatment of traumatically injured patients.
脑氧饱和度（pBtO2）的利用是治疗创伤性脑损伤（TBI）的一个重要但有争议的变量。我们评估了 pBtO2/CPP 与 pBtO2/ICP 之间的相关性，并确定了与生存最密切相关的参数。
回顾性识别连续的、患有严重 TBI 并接受 pBtO2 监测的成年患者。收集 pBtO2、CPP 和 ICP 的时间索引测量值，并确定相关系数。然后根据患者的生存情况对患者进行分层，并比较各组之间的 pBtO2、CPP 和 ICP 值。
在 15 名患者中，共获得了 4169 个时间索引数据点（即 pBtO2 及其相应的 CPP 和 ICP 值）。该队列的平均年龄为 37±17 岁，ISS 为 27±7，GCS 为 4.5±1.5。生存率为 53%（8/15）。在正常回归模型中，ICP（p=0.58）和 CPP（p=0.71）均不能显著预测 pBtO2。在幸存者中，pBtO2 有显著差异（31.5±3.1 对 25.2±4.8，p=0.010），但 CPP 或 ICP 没有差异。幸存者中 pBtO2<25mmHg 的时间比例较低[20%（3.4-44.6）对 40%（16.2-89），p=0.049]。相比之下，幸存者中 CPP<70 的时间比例较大，而 ICP>20 的时间比例无差异。
由于脑氧合与脑血流动力学和压力独立变化，CPP 和 ICP 不应作为 pBtO2 的替代物。TBI 患者的脑组织氧监测提供了有关脑氧合的独特信息，其用途有待进一步描述。
CPP 和 ICP 不是 pBtO2 的替代物。脑组织氧合监测为创伤性损伤患者的治疗提供了独特的信息。
