Gayle M O, Frewen T C, Armstrong R F, Gilbert J J, Kronick J B, Kissoon N, Lee R, Tiffin N, Brown T
Department of Paediatrics, Children's Hospital of Western Ontario, London, Canada.
Crit Care Med. 1989 May;17(5):385-8. doi: 10.1097/00003246-198905000-00001.
Cross-brain oxygen extraction may be altered by coma, hyperventilation, hypothermia, or barbiturates, and has been demonstrated in adults and more recently in children to be related to functional neurologic recovery after a variety of brain injuries. However, measurement of cross-brain oxygen extraction in children is currently not a part of routine clinical care, partly because there have been no published attempts relating the technique of jugular venous bulb (JVB) catheterization and its complication in children. We catheterized the JVB to measure cerebral venous oxygen content and calculate cross-brain oxygen extraction in 26 deeply comatose neonates and children ranging in age from a few hours to 14 yr. Bedside catheterization using the Seldinger technique was successful in 25 children, with standard venous cutdown necessary in the remaining child. All JVB catheterizations were performed with parental consent and during continuous monitoring of the intracranial (ICP) or fontanelle, as well as arterial, pressure. ICP was not significantly altered by the cannulation procedure in any of the children studied, although the cannulation occurred early in the child's course when ICP was well controlled. Inadvertent carotid artery puncture with bleeding controlled by local pressure occurred in four children, and catheter malposition was confirmed on lateral skull xray in two others. Jugular venous bulb catheters remained in place for 2 to 7 days (average 3) and malfunction or obstruction of the catheter did not occur. Organisms were grown from three of 26 catheter tips submitted for culture, with peripheral blood cultures also positive for the same organisms in two of these.(ABSTRACT TRUNCATED AT 250 WORDS)
全脑氧摄取可能会因昏迷、过度通气、低温或巴比妥类药物而改变，并且在成人中已得到证实，最近在儿童中也发现，全脑氧摄取与各种脑损伤后的功能神经恢复有关。然而，目前儿童全脑氧摄取的测量并非常规临床护理的一部分，部分原因是尚未有关于儿童颈静脉球（JVB）置管技术及其并发症的相关报道。我们对26名深度昏迷的新生儿和儿童进行了JVB置管，以测量脑静脉血氧含量并计算全脑氧摄取，这些儿童年龄从几小时到14岁不等。采用Seldinger技术在床边置管，25名儿童成功，其余1名儿童需要进行标准的静脉切开术。所有JVB置管均在获得家长同意后，在持续监测颅内压（ICP）或囟门以及动脉压的情况下进行。在所研究的任何儿童中，置管操作均未使ICP发生显著改变，尽管置管是在儿童病程早期ICP得到良好控制时进行的。4名儿童发生意外颈动脉穿刺，通过局部压迫控制出血，另外2名儿童经头颅侧位X线证实导管位置不当。颈静脉球导管留置2至7天（平均3天），未发生导管故障或阻塞。在送检培养的26个导管尖端中，有3个培养出微生物，其中2个的外周血培养也发现相同微生物呈阳性。（摘要截短于250字）
