摘要
目的：探讨颈内动静脉血氧饱和度差值（Sa-jvo2）在重度颅脑损伤术后撤机中的预测价值。方法：将34例重度颅脑损伤术后机械通气患者（GCS 3~8分）应用随机数字表法分为经验组和对照组。经验组拔管指征为术后常规处理后循环、内环境稳定,手触骨窗压力不高,经气管插管吸痰呛咳白卡片法阳性,T管行自主呼吸试验（SBT）通过后半小时后复查血气分析无异常,予拔除气管插管。对照组在经验拔管指征符合后监测Sa-jvo2,若Sa-jvo2〈25%,暂不予脱机拔管,给予镇痛镇静加强气道管理,继续予机械通气支持,必要时予加强脑脱水、保证脑灌注压等处理,直至Sa-jvo2≥25%再予以脱机拔管。比较两组撤机成功率、再插管率、肺部感染发生率、两周后患者GCS评分及1个月后GOS预后评分。结果：对照组脱机拔管成功率明显高于经验组,经验组的再插管率高于对照组,两者之间差异有统计学意义（P〈0.01）。对照组和经验组之间肺部感染发生率无明显差异（P〉0.05）。两周后GCS评分,对照组高于经验组,1个月后GOS评分对照组高于经验组,差异有统计学意义（P〈0.01）。结论：在经验拔管的基础上,把Sa-jvo2作为撤机的预测指标能够提高重度颅脑损伤患者术后撤机成功率,能够改善患者预后。
Objective： To study the predicting value of Sa-jvo2 in weaning of severe craniocerebral injury patients after surgery. Methods： 34 mechanical pneumato-permitation patients after surgery with severe craniocerebral injury （GCS 3-8 ） were randomized into experience group and control group by digit-tabulation. The experience group （17 cases）extubation criterion： pressure of hand-touching bone window is not high after conventional treatment cy- cle, stable internal environment, suction by endotracheal intubation is positive by choking white card law, passed after the T-tube line SBT, half an hour after the review no abnormal blood gas analysis. Control group（ 17 cases） ex- tubation criterion：it is in compliance with the monitoring jugular venous oxygen saturation difference when beyond experience group extubation criterion,if Sa-jvo2 〈 25%, temporarily offline extubation not give sedation to strength-en airway management, continues to mechanical ventilation support and strengthen the brain dehydration when nec- essary, to ensure cerebral perfusion pressure and other processing until the Sa-jvo2≥25%, and then be off extuba- tion. Weaning success rates were compared, the rate of re- intubation pulmonary infection incidence in patients with GCS score after two weeks and GOS score after one month were compared. Results： The success rate of the control group was significantly higher than the experience group, the experince group had higher rates of intubation, there was significant differences between the two groups （ P 〈 0.01 ）. Lung infection between the control group and the experince group had no significant difference in the incidence （ P 〉 0.05 ）. GCS score of the control group two weeks later was higher than the experience group, GOS score at one month later of the control group was higher than the experience group, there was a significant difference between the two groups （P 〈 0.01 ）. Conclusion： Based on the experience of extubation, the dynamic internal jugular venous oxygen saturation difference weaning predictors of severe traumatic brain injury can improve postoperative weaning success rate, can improve the progno- sis of patients.
出处
《现代医学》
2014年第10期1169-1172,共4页
Modern Medical Journal
