Nara I, Shiogai T, Hara M, Saito I
Department of Neurosurgery, Kyorin University School of Medicine, Tokyo, Japan.
Acta Neurochir Suppl. 1998;71:22-6. doi: 10.1007/978-3-7091-6475-4_7.
In order to select the optimal neurointensive treatment for patients with severe head injury and intracranial hypertension, the effects of hypothermia (HT), barbiturates (BT), and osmotic agents (OT) on focal and diffuse cerebral oxygen metabolism were evaluated by means of continuous monitoring of bifrontal regional oxygen saturation (rSO2), jugular bulb oxygen saturation (SjO2), jugular bulb temperature (Tjb), intracranial pressure (ICP), and cerebral perfusion pressure (CPP).
Cerebral oxygen metabolism in SjO2 and rSO2, ICP, CPP, and Tjb were continuously monitored in severe head injury patients with Glasgow Coma Scale < 8, ages 10-62: 13 with focal and 10 with diffuse injuries. The effects of BT (n = 6), HT (n = 9), and OT (n = 8) on these parameters (ICP/CPP, SjO2, and rSO2) were compared. Evaluations were performed in terms of: a) Percentage of abnormal values based on normal control values; ICP < 20 mm Hg, CPP > 60 mm Hg, SjO2 55-75%, and rSO2 60-80% were calculated, b) Effects of pentobarbital dose (mg/kg/h) for the parameters compared among < 1.0, 1.1-2.0, 2.1-3.0, and > 3.1. c) Effects of Tjb (degree C) on parameters compared among hyperthermia (> 38 degrees C), normothermia (36-37.9 degrees C), mild hypothermia (34-35.9 degrees C) and moderate hypothermia (< 33.9 degrees C).
a) Abnormal data differed significantly among the three treatment groups. rSO2 showing ischemia on the affected side was more marked in BT than in HT or OT. b) ICP decreases and CPP increases correlated significantly with the pentobarbital dose. c) ICP decreases and CPP increases correlated significantly with decreased Tjb.
The therapeutic effects of hypothermia, barbiturates, and osmotherapy on cerebral oxygen metabolism and ICP/CPP are different according to the underlying pathological lesions of patients with severe head injury.
为了为重度颅脑损伤和颅内高压患者选择最佳的神经强化治疗方法，通过连续监测双侧额叶局部氧饱和度（rSO2）、颈静脉球氧饱和度（SjO2）、颈静脉球温度（Tjb）、颅内压（ICP）和脑灌注压（CPP），评估了低温（HT）、巴比妥类药物（BT）和渗透性药物（OT）对局灶性和弥漫性脑氧代谢的影响。
对格拉斯哥昏迷量表＜8、年龄10 - 62岁的重度颅脑损伤患者连续监测SjO2和rSO2中的脑氧代谢、ICP、CPP和Tjb：13例为局灶性损伤，10例为弥漫性损伤。比较了BT（n = 6）、HT（n = 9）和OT（n = 8）对这些参数（ICP/CPP、SjO2和rSO2）的影响。评估依据以下方面进行：a）基于正常对照值的异常值百分比；计算ICP＜20 mmHg、CPP＞60 mmHg、SjO2 55 - 75%和rSO2 60 - 80%，b）戊巴比妥剂量（mg/kg/h）对＜1.0、1.1 - 2.0、2.1 - 3.0和＞3.1之间比较的参数的影响。c）Tjb（℃）对高热（＞38℃）、正常体温（36 - 37.9℃）、轻度低温（34 - 35.9℃）和中度低温（＜33.9℃）之间比较的参数的影响。
a）三个治疗组之间异常数据有显著差异。BT组患侧显示缺血的rSO2比HT组或OT组更明显。b）ICP降低和CPP升高与戊巴比妥剂量显著相关。c）ICP降低和CPP升高与Tjb降低显著相关。
根据重度颅脑损伤患者的潜在病理损伤情况，低温、巴比妥类药物和渗透性疗法对脑氧代谢和ICP/CPP的治疗效果不同。
