近红外光谱无创监测局部脑氧饱和度在重型颅脑损伤术后治疗中的应用研究

摘要

目的 探讨近红外光谱技术(NIRS)实时无创监测重型颅脑损伤术后局部脑氧饱和度(rScO2)的变化规律以及与颅内压(ICP)之间的相关性.方法 选择24例重度颅脑损伤急诊术后病人,采用近红外光谱与有创颅内压监测仪持续监测rScO2、ICP,同时记录脉氧饱和度(SpO2)、平均动脉压(MAP)、脑灌注压(CPP),采用SPSS统计学方法分析监测结果的关联性.结果 重度颅脑损伤预后程度和rScO2差异有统计学意义,预后越好的组其rScO2值越高,术后rScO2早期会出现下降,最后随颅内高压缓解后再次呈上升趋势.但4例死亡病人伤后rScO2主要呈下降趋势,上升不明显.rScO2与ICP呈显著负相关(r=-0.882,P<0.001),rScO2与CPP呈显著正相关(r=0.938,P<0.001).结论 近红外光谱技术可以准确无创监测脑组织rScO2,对于重型颅脑损伤治疗及预后评估有着重要意义.%Objective To investigate the changes of regional cerebral oxygen saturation (rScO2) in patients with severe brain injury after operation which were continuously monitored by near infrared spectroscopy (NIRS) and the correlation between the changes of regional cerebral oxygen saturation and intracranial pressure (ICP).Methods Twenty four patients with severe brain injury after emergency operation were given continuously monitoring of regional cerebral oxygen saturation and intracranial pressure by near infrared spectroscopy and invasive intracranial pressure monitor.Meanwhile pulse oxygen saturation (SpO2),mean arterial blood pressure (MAP) and cerebral perfusion pressure (CPP) were monitored.The correlation of monitoring results was analyzed by SPSS statistics analysis.Results The prognosis of severe brain injury and rScO2 statistically significant.The rScO2 reduced in the early postoperative period.As the intracranial pressure relieves it increases.But the rScO2 in 4 cases of death decline as others subsequently it increased while the ascending trend was not obvious.A significant negative correlation between the rScO2 and ICP (r=-0.882,P<0.001),and a positive correlation between the rScO2 and CPP (r=0.938,P<0.001).Conclusions Near infrared spectroscopy technology can accurately noninvasive monitoring of regional cerebral oxygen saturation,which is of great significance for the treatment and prognosis of patients with severe brain injury.