von Helden A, Schneider G H, Unterberg A, Lanksch W R
Department of Neurosurgery, University Hospital Rudolf Virchow, Free University of Berlin, Federal Republic of Germany.
Acta Neurochir Suppl (Wien). 1993;59:102-6. doi: 10.1007/978-3-7091-9302-0_18.
To prevent secondary cerebral ischemia in comatose patients it would be of great importance to assess cerebral blood flow. Recently monitoring of the jugular venous oxygen saturation (SJVO2) has been shown to continuously evaluate cerebral oxygenation and to estimate cerebral blood flow. While most of these studies have dealt with severely head injured patients, we investigated cerebral oxygenation in 50 comatose patients due to an intracerebral haematoma (n = 14), subarachnoid haemorrhage (n = 12) and severe head injury (n = 24). In these groups of patients, the reaction of SJVO2 to hyperventilation and to lowering of blood pressure was studied. Moderate hyperventilation from 35 to 28 mmHg resulted in a significant decrease of SJVO2 in all groups. A critical SJVO2 between 50 and 55% was found in one half of the patients studied, a pathological SJVO2 below 50% was seen in 23% of the cases. Lowering of arterial blood pressure within the limits of autoregulation resulted in decreases of SJVO2 in patients with intracerebral haematomas only. 55% of these patients showed signs of insufficient cerebral oxygenation. Furthermore the frequency of spontaneous desaturation episodes was studied retrospectively and comparison made between the different groups. These episodes were found more frequently in patients with intracerebral haematomas compared to patients with severe head injury. In conclusion, monitoring of jugular venous oxygen saturation is a valuable tool for detecting and treating insufficient cerebral oxygenation in comatose patients following intracerebral haemorrhage, subarachnoid haemorrhage and severe head injury.
为预防昏迷患者发生继发性脑缺血，评估脑血流量具有重要意义。最近的研究表明，监测颈静脉血氧饱和度（SJVO2）可连续评估脑氧合情况并估计脑血流量。虽然大多数此类研究针对的是重度颅脑损伤患者，但我们对50例因脑内血肿（n = 14）、蛛网膜下腔出血（n = 12）和重度颅脑损伤（n = 24）而昏迷的患者进行了脑氧合情况调查。在这些患者组中，研究了SJVO2对过度通气和血压降低的反应。从35 mmHg适度过度通气至28 mmHg导致所有组的SJVO2均显著下降。在所研究的患者中，一半患者的临界SJVO2在50%至55%之间，23%的病例出现低于50%的病理性SJVO2。仅在脑内血肿患者中，在自动调节范围内降低动脉血压会导致SJVO2下降。这些患者中有55%表现出脑氧合不足的迹象。此外，还回顾性研究了自发去饱和事件的发生频率，并对不同组进行了比较。与重度颅脑损伤患者相比，脑内血肿患者中这些事件更为常见。总之，监测颈静脉血氧饱和度是检测和治疗脑出血、蛛网膜下腔出血及重度颅脑损伤后昏迷患者脑氧合不足的一项有价值的工具。
