局部脑氧饱和度监测目标导向治疗在老年重度颅脑损伤患者中的应用

Application of target-oriented therapy with dynamical monitoring of regional cerebral oxygen saturation in treatment of severe traumatic brain injury in the elderly

摘要:

目的 评价局部脑氧饱和度(rScO₂)监测目标导向治疗老年重度颅脑损伤(sTBI)患者的临床价值。方法 选取2018年4月至2020年11月于内蒙古自治区人民医院神经外科重症监护病房(NSICU)治疗的60例老年重度颅脑损伤患者,采用随机数表法分为研究组和对照组,每组各30例。对照组给予神经外科重症传统监护治疗管理,研究组在实施神经外科重症传统监护治疗管理基础上予以rScO₂目标监测指导治疗。比较2组患者格拉斯哥昏迷评分(GCS)和格拉斯哥预后评分(GOS)、NSICU住院时间、死亡率及改良Rankin量表评分。采用SPSS 24.0 统计软件进行数据分析。根据数据类型,分别采用t检验和χ²检验进行组间比较。生存分析采用Kaplan-Meier生存曲线。结果 2组患者出院时GCS评分均较入院初始提高,但差异无统计学意义(P>0.05)；出院时研究组患者GCS评分高于对照组,但差异无统计学意义(P>0.05)。研究组在NSICU时间较对照组明显减少(P<0.05)。随访6个月,研究组与对照组相比,改良 Rankin 量表评分更低,GOS更高,生存时间更长,死亡率更低(均P<0.05)。 结论 rScO₂监测目标导向治疗能有效缩短老年STBI患者的NSICU住院时间,改善患者预后,降低病死率。

Abstract:

Objective To explore the clinical value of target-oriented therapy of monitoring regional cerebral oxygen saturation (rScO₂) in the elderly patients with severe traumatic brain injury (sTBI). Methods A total of 60 patients aged over 60 years with severe craniocerebral injury treated in the neurosurgical intensive care unit (NSICU) of our hospital from April 2018 to November 2020 were enrolled, and then randomly divided into study group and control group, with 30 patients in each group. The control group was given traditional neurosurgical intensive care management, and the study group was given targeted therapy under the direction of monitoring rScO₂ on the basis of conventional neurosurgical intensive care management. Glasgow coma score (GCS) and Glasgow outcome score (GOS), NSICU length of stay, mortality, and modified Rankin scale scores were compared between two groups. SPSS statistics 24.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for intergroup comparison based on different data types. Kaplan-Meier survival curve was used for survival analysis. Results At discharge, the Glasgow coma score (GCS) was increased than that at admission in both groups, but no statistical difference was observed between them (P>0.05), though the score in the study group higher than that of control group (P>0.05). The length of stay in NSICU was significantly shorter in the study group than the control group (P<0.05). After 6 months of follow-up, the study group had obviously lower score of Modified Rankin Scale (mRS), higher GOS, longer survival time and lower mortality when compared with the control group (all P<0.05). Conclusion The targeted therapy under the direction of monitoring rScO₂ can effectively shorten the length of NSICU stay, improve the prognosis and reduce the mortality rate in the elderly sTBI patients.