Bardt T F, Unterberg A W, Härtl R, Kiening K L, Schneider G H, Lanksch W R
Department of Neurosurgery, Virchow Medical Center, Humboldt University, Berlin, Federal Republic of Germany.
Acta Neurochir Suppl. 1998;71:153-6. doi: 10.1007/978-3-7091-6475-4_45.
This study investigates the effect of hypoxic brain tissue PO2 on outcome, and examines the incidence of possible causes for cerebral hypoxia. We studied 35 patients with severe head injury (GCS < or = 8). Age was 33.2 (+/- 11.3) years. Total time of monitoring of PtiO2, intracranial pressure (ICP), cerebral perfusion pressure (CPP), and endtidal PCO2 (ETCO2) was 119.3 (+/- 65.7) hours. Data were continuously recorded by a computer system. Outcome was assessed at discharge and after 6 months post injury. 56% of the patients with more than 300 minutes of PtiO2 < 10 mm Hg died, 22% had an unfavourable outcome, 22% had a favourable outcome. Cerebral hypoxia was associated with intracranial hypertension (ICP > 20 mm Hg) in 11.5 (+/- 15.1)%. CPP was compromised below 60 mm Hg in 16.8 (+/- 23.4)%. Hypocarbia (ETCO2 < 28 mm Hg) was present in 48.0% of the time of PtiO2 < 10 mm Hg. No obvious cause for cerebral hypoxia was found in 45% of the data. These result underscore the association of cerebral hypoxia with poor neurological outcome and stress the meaning of monitoring of PtiO2 as an independent parameter in patients following TBI.
本研究调查了缺氧脑组织的氧分压对预后的影响，并检测了脑缺氧可能原因的发生率。我们研究了35例重度颅脑损伤患者（格拉斯哥昏迷评分≤8分）。年龄为33.2（±11.3）岁。对脑组织氧分压（PtiO2）、颅内压（ICP）、脑灌注压（CPP）和呼气末二氧化碳分压（ETCO2）的总监测时间为119.3（±65.7）小时。数据由计算机系统持续记录。在出院时和伤后6个月评估预后。PtiO2＜10 mmHg持续超过300分钟的患者中，56%死亡，22%预后不良，22%预后良好。11.5（±15.1）%的脑缺氧与颅内高压（ICP＞20 mmHg）有关。16.8（±23.4）%的患者CPP低于60 mmHg。在PtiO2＜10 mmHg的时间段内，48.0%的时间存在低碳酸血症（ETCO2＜28 mmHg）。45%的数据中未发现明显的脑缺氧原因。这些结果强调了脑缺氧与不良神经预后之间的关联，并强调了在创伤性脑损伤患者中监测PtiO2作为独立参数的意义。
