2021 年第 12 期 第 16 卷

颈内静脉球部血氧饱和度与颅内压联合监测对重症监护病房脑出血术后患者预后的评估价值

Prognostic value of internal jugular vein bulb oxygen saturation and intracranial pressure combined monitoring in patients with intracerebral hemorrhage in intensive care unit after operation 

作者：邹帅陈果陈钇然张婷李灿袁智慧刘亚林

英文作者：Zou Shuai Chen Guo Chen Yiran Zhang Ting Li Can Yuan Zhihui Liu Yalin

单位：重庆市第五人民医院重症医学科400062

英文单位：Intensive Care Unit Chongqing Fifth People′s Hospital Chongqing 400062 China

关键词：脑出血；颈内静脉血氧饱和度；颅内压；预后评价

英文关键词：Intracerebralhemorrhage;Internaljugularveinoxygensaturation;Intracranialpressure;

• 摘要：

• 目的 分析颈内静脉血氧饱和度(SjvO2)与颅内压联合监测对重症监护病房（ICU）脑出血术后患者预后的评估价值，为临床识别高危患者、判断患者预后提供更完善的理论依据。方法 选取2017年6月至2020年6月重庆市第五人民医院重症医学科收治的50例脑出血术后患者为研究对象。按照SjvO2将50例患者分为SjvO2正常组（16例）、SjvO2升高组（12例）和SjvO2降低组（22例）。比较各组研究对象的SjvO2、颅内压、格拉斯哥昏迷量表（GCS）评分、急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分及颈动静脉血氧含量差（AVDO2）、脑氧摄取率（CEO2）。分析SjvO2与颅内压联合监测对预后不良事件的预测价值。结果  术后相同时点SjvO2正常组患者的颅内压水平及APACHE Ⅱ评分低于SjvO2升高组和SjvO2降低组、GCS评分高于SjvO2升高组和SjvO2降低组，差异均有统计学意义（均P<0.05）。术后相同时点SjvO2降低组患者的AVDO2和CEO2水平均明显低于SjvO2正常组；术后12、24 h及2 d SjvO2 升高组患者的AVDO2和CEO2水平高于SjvO2正常组，随后迅速降低，差异均有统计学意义（均P<0.05）。SjvO2与颅内压联合监测的曲线下面积、敏感度和特异度均明显高于SjvO2和颅内压单独监测（0.830比0.773、0.692，75.2%比70.5%、65.4%，83.3%比75.3%、70.0%），差异均有统计学意义（均P<0.05）。结论  SjvO2与颅内压联合监测对ICU脑出血术后患者预后评估具有重要的参考价值。

• Objective To analyze the prognostic value of internal jugular vein oxygen saturation (SjvO2) and intracranial pressure (ICP) combined monitoring in patients with intracerebral hemorrhage in intensive care unit (ICU) after operation, and to provide a more perfect theoretical basis for clinical identification of high-risk patients and judgment of patients′ prognosis. Methods From June 2017 to June 2020, 50 patients with intracerebral hemorrhage after operation treated in Department of Intensive Care Unit, Chongqing Fifth People′s Hospital were selected. According to SjvO2, 50 patients were divided into SjvO2 normal group(16 cases), SjvO2 increased group(12 cases) and SjvO2 decreased group(22 cases). SjvO2, ICP, Glasgow coma scale(GCS) score, acute physiology and chronic health evaluation system Ⅱ(APACHE Ⅱ) score, jugular arteriovenous oxygen content difference(AVDO2) and cerebral oxygen uptake rate(CEO2) were compared among the groups. The predictive value of SjvO2 and ICP combined monitoring in prognostic adverse events was analyzed. Results At the same time point after operation, the ICP level and APACHE Ⅱ score in SjvO2 normal group were lower than those in SjvO2 increased group and SjvO2 decreased group, and the GCS score in SjvO2 normal group was higher than that in SjvO2 increased group and SjvO2 decreased group(all P<0.05). The levels of AVDO2 and CEO2 in SjvO2 decreased group were significantly lower than those in SjvO2 normal group at the same time point after operation; the levels of AVDO2 and CEO2 in SjvO2 increased group were higher than those in SjvO2 normal group at 12, 24 h and 2 d after operation, and then decreased rapidly(all P<0.05). The area under the curve, sensitivity and specificity of SjvO2 and ICP combined monitoring were significantly higher than those of SjvO2 and ICP alone (0.830 vs 0.773, 0.692; 75.2% vs 70.5%, 65.4%; 83.3% vs 75.3%, 70.0%)(all P<0.05). Conclusion  The SjvO2 and ICP combined monitoring has important reference value for the prognosis of patients with intracerebral hemorrhage in ICU after operation.