CONTINUOUS MONITORING OF JUGULAR VENOUS OXYGEN-SATURATION IN HEAD-INJURED PATIENTS
CONTINUOUS MONITORING OF JUGULAR VENOUS OXYGEN-SATURATION IN HEAD-INJURED PATIENTS
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DOI：
10.3171/jns.1992.76.2.0212
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发表时间：
1992-02-01
影响因子：
4.1
通讯作者：
GROSSMAN, RG
中科院分区：
文献类型：
--
作者：
SHEINBERG, M;KANTER, MJ;GROSSMAN, RG
用光纤导管连续测量颈静脉血氧饱和度(SjvO2)是检测颅脑损伤后脑缺血的一种方法。对45例重型颅脑损伤后昏迷入院的患者进行了SjvO2、颅内压、动脉血氧饱和度和呼气末二氧化碳的持续同步监测。每8小时测量一次脑血流量、脑氧和乳酸代谢率、动脉和颈静脉血气、血红蛋白浓度，持续1~11天。当SjvO2降至50%以下时，遵循标准化方案以确认减饱和度的有效性并确定其原因。在体内校准后，当导管末端有足够的光强度时，通过导管获得的SjvO2值与通过导管抽取的静脉血的CO血氧计直接测量的O2饱和度之间的相关性非常好(176次测量：r=0.87，p<；0.01)。45例患者共发生60次颈静脉血氧减饱和。在20例患者中，CO血氧仪确认了减饱和值。20例患者中33例出现低饱和度，原因如下：颅内高压12例，低碳酸血症10例，动脉低氧6例，上述3例合并低血压，1例全身性低血压，1例脑血管痉挛。本研究发现颈静脉血氧饱和度降低的发生率提示持续监测SjvO2在颅脑损伤患者中可能具有临床价值。
The continuous measurement of jugular venous oxygen saturation (SjvO2) with a fiberoptic catheter is evaluated as a method of detecting cerebral ischemia after head injury. Forty-five patients admitted to the hospital in coma after severe head injury had continuous and simultaneous monitoring of SjvO2, intracranial pressure, arterial oxygen saturation, and end-tidal CO2. Cerebral blood flow, cerebral metabolic rates of oxygen and lactate, arterial and jugular venous blood gas levels, and hemoglobin concentration were measured every 8 hours for 1 to 11 days. Whenever SjvO2 dropped to less than 50%, a standardized protocol was followed to confirm the validity of the desaturation and to establish its cause. Correlation of SjvO2 values obtained by catheter and with direct measurement of O2 saturation by a co-oximeter on venous blood withdrawn through the catheter was excellent after in vivo calibration when there was adequate light intensity at the catheter tip (176 measurements: r = 0.87, p < 0.01). A total of 60 episodes of jugular venous oxygen desaturation occurred in 45 patients. In 20 patients the desaturation value was confirmed by the co-oximeter. There were 33 episodes of desaturation in these 20 patients, due to the following causes: intracranial hypertension in 12 episodes, hypocarbia in 10, arterial hypoxia in six, combinations of the above in three, systemic hypotension in one, and cerebral vasospasm in one. The incidence of jugular venous oxygen desaturations found in this study suggests that continuous monitoring of SjvO2 may be of clinical value in patients with head injury.