脑组织氧合的前 72 小时可预测创伤性脑损伤患者的生存情况。

The first 72 hours of brain tissue oxygenation predicts patient survival with traumatic brain injury.

机构信息

Division of General/Trauma Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.

出版信息

J Trauma Acute Care Surg. 2012 May;72(5):1345-9. doi: 10.1097/TA.0b013e318249a0f4.

DOI:10.1097/TA.0b013e318249a0f4

PMID:22673264

Abstract

BACKGROUND

Utilization of brain tissue oxygenation (pBtO(2)) is an important but controversial variable in the treatment of traumatic brain injury. We hypothesize that pBtO(2) values over the first 72 hours of monitoring are predictive of mortality.

METHODS

Consecutive, adult patients with severe traumatic brain injury and pBtO(2) monitors were retrospectively identified. Time-indexed measurements of pBtO(2), cerebral perfusion pressure (CPP), and intracranial pressure (ICP) were collected, and average values over 4-hour blocks were determined. Patients were stratified according to survival, and repeated measures analysis of variance was used to compare pBtO(2), CPP, and ICP. The pBtO(2) threshold most predictive for survival was determined.

RESULTS

There were 8,759 time-indexed data points in 32 patients. The mean age was 39 years ± 16.5 years, injury severity score was 27.7 ± 10.7, and Glasgow Coma Scale score was 6.6 ± 3.4. Survival was 68%. Survivors consistently demonstrated higher pBtO(2) values compared with nonsurvivors including age as a covariate (F = 12.898, p < 0.001). Individual pBtO(2) was higher at the time points 8 hours, 12 hours, 20 hours to 44 hours, 52 hours to 60 hours, and 72 hours of monitoring (p < 0.05). There was no difference in ICP (F = 1.690, p = 0.204) and CPP (F = 0.764, p = 0.389) values between survivors and nonsurvivors including age as a covariate. Classification and regression tree analysis identified 29 mm Hg as the threshold at which pBtO(2) was most predictive for mortality.

CONCLUSION

The first 72 hours of pBtO(2) neurologic monitoring predicts mortality. When the pBtO(2) monitor remains below 29 mm Hg in the first 72 hours of monitoring, mortality is increased. This study challenges the brain oxygenation threshold of 20 mm Hg that has been used conventionally and delineates a time for monitoring pBtO(2) that is predictive of outcome.

LEVEL OF EVIDENCE

III, prognostic study.

摘要

背景

脑组织氧合（pBtO2）的利用是治疗创伤性脑损伤的一个重要但有争议的变量。我们假设监测开始后前 72 小时内的 pBtO2 值可预测死亡率。

方法

连续回顾性识别患有严重创伤性脑损伤和 pBtO2 监测仪的成年患者。采集了 pBtO2、脑灌注压（CPP）和颅内压（ICP）的时间索引测量值，并确定了 4 小时块的平均值。根据存活情况对患者进行分层，并使用重复测量方差分析比较 pBtO2、CPP 和 ICP。确定最能预测存活的 pBtO2 阈值。

结果

32 例患者共有 8759 个时间索引数据点。平均年龄为 39 岁±16.5 岁，损伤严重程度评分 27.7±10.7，格拉斯哥昏迷评分 6.6±3.4。存活率为 68%。幸存者的 pBtO2 值始终高于非幸存者，包括年龄作为协变量（F=12.898，p<0.001）。包括年龄作为协变量时，在监测的 8 小时、12 小时、20 小时至 44 小时、52 小时至 60 小时和 72 小时时间点，个体 pBtO2 更高（p<0.05）。包括年龄作为协变量时，幸存者和非幸存者之间的 ICP（F=1.690，p=0.204）和 CPP（F=0.764，p=0.389）值无差异。分类和回归树分析确定 29mmHg 为 pBtO2 对死亡率最具预测性的阈值。