| Background:The craniocerebral trauma, especially the severe craniocerebral injury patients showed a trend of increase gradually, the pure Glasgow coma score (GCS) is not accurate, and the skull puncture into spectrum monitoring electrodes to monitor the clinical does not apply. For internal jugular venous blood oxygen saturation (Sjvo2) monitoring in the European and American countries are widely used in the clinical treatment of patients with severe head injury, has been relatively mature, but there are still not many domestic currently carried out. Most of patients with severe craniocerebral injury admitted in intensive care units need mechanical ventilation support, due to its deep coma, it is difficult to judge prognosis of early clinical manifestations. And through the internal jugular vein retrograde insertion test Sjvo2indicators, and eliminate the patient’s body temperature, blood pressure, whether be agitated, low hemoglobin, partial pressure of Carbon dioxide (PCO2), oxygen partial pressure fluctuations (PO2), and other indicators of results of interference, can accurate assessment of the patients with intracranial oxygen consumption situation, provide the powerful data support for the early clinical judgment.Objective:Through the changes in cerebral circulation in patients with severe head injury in different periods of internal jugular venous blood oxygen saturation (Sjvo2), and other indicators to monitor, to explore the clinical research of Sjvo2on prognosis of patients with such determination, guide clinical treatment.Methods:Judge the prognosis of patients with severe craniocerebral trauma, the key is in patients within5days after injury, This research through the Sjvo2and related indicators monitoring shows that, Low perfusion period is injured on the same day, Sjvo2levels below normal, congestion period for1～3days after injury, Sjvo2levels higher than normal, cerebral vasospasm period for5～16days after injury, Sjvo2basic close to normal。Sjvo2value either too high or too low Sjvo2values indicate that poor prognosis. This experiment to enter intensive medicine mechanical ventilation in patients with severe craniocerebral trauma, after evaluating system on examination and the condition, internal jugular vein retrograde catheter for blood collection and puncture radial artery indwelling catheter, monitoring of internal jugular venous blood oxygen saturation (Sjvo2), internal jugular venous blood oxygen partial pressure (Pjo2) and radial artery blood oxygen saturation (SAO2) and radial artery blood oxygen partial pressure (PAO2), and calculate the difference of venous blood oxygen saturation (AVDO2), cerebral oxygen uptake (CEO2). According to the situation of patients at discharge is divided into death group, survival group. Survival group according to the result of after3months of Glasgow again (GCS) score, divided into severe disability and mild disability, respectively in different periods of patients Sjvo2, Pjo2, PAO2, SAO2, CEO2, AVDO2indicators such as statistical analysis.Results:Both groups such as age, gender and APACHE Ⅱ score on admission based data comparison difference has no statistical significance (P>0.05), there are comparable.In this study, according to the injury in the low perfusion, death group internal jugular venous blood oxygen saturation (Sjvo2) is lower than the survival group, and stage in congestion and vascular spasm, internal jugular venous blood oxygen saturation (Sjvo2) death group were significantly higher than the survival group (P<0.05), and its prognosis have obvious correlation.Conclusions:Through this study of patients with severe craniocerebral trauma Sjvo2monitoring and analysis, the conclusions are as follows:internal jugular venous blood oxygen saturation (Sjvo2) is to evaluate the prognosis of patients with severe craniocerebral trauma in early a good indicator. Early Sjvo2value whether it is too high or too low Sjvo2values indicate that poor prognosis. |
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