Bullock R, Stewart L, Rafferty C, Teasdale G M
University Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, Scotland, U.K.
Acta Neurochir Suppl (Wien). 1993;59:113-8. doi: 10.1007/978-3-7091-9302-0_20.
The laser absorption spectrophotometric technique was used to continuously monitor jugular bulb oxygen saturation (SjO2), and thus to calculate arteriovenous oxygen differences (AVDO2), in three subgroups of intensively monitored, severely head injured patients. We have used this data to address two questions: 1. How do cerebral and systemic haemodynamic changes affect SjO2 and AVDO2; and 2. Can ADVO2 measurements be used to detect therapeutic changes in brain metabolism, in response to drugs. The major haemodynamic factor affecting SjO2 and AVDO2 was intracranial pressure (ICP). Increases in ICP were associated with concomitant increases in SjO2, and decreases in AVDO2, suggesting cerebral hyperaemia in response to ICP waves. Systemic changes were less frequent, but potent influences on SjO2. The short acting anaesthetic agent propofol produced a marked increase in SjO2 (decrease in AVDO2 to below the normal range) which became less marked with time. A new high affinity glutamate antagonist produced no change in SjO2. With rigorous attention to technical factors, and exclusion of extra and intracranial haemodynamic effects, SjO2 monitoring may be a useful "surrogate end point" for the effect of drugs acting on brain metabolism.
采用激光吸收分光光度技术对三组重症监护的重型颅脑损伤患者连续监测颈静脉球血氧饱和度（SjO2），并据此计算动静脉氧差（AVDO2）。我们利用这些数据来回答两个问题：1. 脑血流动力学和全身血流动力学变化如何影响SjO2和AVDO2；2. AVDO2测量能否用于检测药物作用下脑代谢的治疗性变化。影响SjO2和AVDO2的主要血流动力学因素是颅内压（ICP）。ICP升高与SjO2的相应升高以及AVDO2的降低相关，提示对ICP波动的脑充血反应。全身变化较少见，但对SjO2有显著影响。短效麻醉剂丙泊酚使SjO2显著升高（AVDO2降低至正常范围以下），且随着时间推移这种变化变得不那么明显。一种新型高亲和力谷氨酸拮抗剂对SjO2无影响。在严格关注技术因素并排除颅外和颅内血流动力学影响的情况下，SjO2监测可能是作用于脑代谢药物效果的有用“替代终点”。
