腦組織氧氣監測器應用於創傷性腦損傷病人之研究

Application of Brain Tissue Oxygen Monitoring in Patients with Traumatic Brain Injury

孫靜軒(Ching- Shuan Sun)

指導教授 ： 邱文達

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2009年)

https://doi.org/10.6831/TMU.2009.00102

摘要

目的：評估創傷性腦損傷患者裝置腦組織氧氣監測器與顱內壓監測器
的介入治療是否能降低患者死亡率並改善其功能性預後結果
方法：本計劃為隨機分派且具控制組的臨床研究，收案對象是其昏迷
指數為3-12分之中重度創傷性腦損傷患者，且年齡大於17歲
以上，收案期間為2008.1.1~ 2009.5.1，收案地點為六家醫學
中心的神經重症加護中心。實驗組使用腦組織氧氣監測器與內
壓監測器，以調控腦組織氧氣分壓> 20mmHg、顱內壓< 20
mmHg以及腦灌流壓> 60mmHg為治療目標。控制組只使用顱
內壓監測器監測，以調控顱內壓< 20mmHg、腦灌流壓> 60
mmHg為治療目標。
結果：符合收案條件者共有60名患者，男性43人，女性17人，男
女比例約為2.5:1。隨機分派進入實驗組或控制組，實驗組有
20人，平均年齡為49.8± 24.1，控制組有40人，平均年齡為
51.4± 21.5。研究證實當創傷性腦損傷患者出現肺部合併症時
，使用腦組織氧氣監測器持續監測並調控比例式氧氣濃度來增
加動脈血氧分壓藉以提高腦組織氧氣分壓的介入方式，是能夠
有效的預防並改善肺部狀況。此外控制組的死亡率為35%，而
實驗組的死亡率明顯降低為10% (P< 0.05)。而在受傷後六個
月 的GOSE的評估方面，實驗組預後較佳的百分比(67%)比控制
組預後較佳的百分比(35%)，相較之下多了32% (P< 0.05)。
結論：證實裝置腦組織氧氣監測器與顱內壓監測器持續監測並調控各
項參數介入方式的患者會比僅單獨裝置顱內壓監測器的患者能
夠有效的改善肺部狀況且有較低的死亡率及較好的功能性預後
結果。

關鍵字

腦組織氧氣監測器 ； 顱內壓監測器 ； 創傷性腦損傷 ； 肺功能

並列摘要

Purpose：To determine whether the applications of brain tissue oxygen monitoring system and intracranial pressure monitoring system on traumatic brain injury patient were associated with reduction of mortality rate and improved patient outcome.
Method：This study is a retrospective randomized-controlled clinical trial from January 01, 2008 to May 01, 2009. All the subjects are moderate-severe traumatic brain injury patients with GCS is 3-12, age greater than 17 years old, and admitted to neurological critical intensive units in 6 medical centers. Case group has used brain tissue oxygen monitoring system and intracranial pressure monitoring system to keep brain tissue oxygen tension (PbtO2) >20mmHg. intracranial pressure (ICP) < 20 mmHg and cerebral perfusion pressure (CPP)>60mmHg.Control group has use only
intracranial pressure monitoring system to keep ICP < 20mmHg and cerebral perfusion pressure CPP > 60mmHg.
Result：There are total 60 patients included into this trial. There are 43 males and 17 females with male to female ration 2.5:1. Case group consists of 20 patients with mean age of 49.8± 24.1 years. Control group consists of 40 patients with mean age of 51.4± 21.5 years. This study shows when there is pulmonarycomplication in traumatic brain injury patients, continue use of brain tissue oxygen monitoring system to adjust FiO2 to increase
PaO2 thus maintain PbtO2 can effectively preserve and improve pulmonary function. The mortality rate is 10% for the case group which is significantly lower than the control group with mortality rate 35% (P< 0.05). Evaluation of GOS/GOSE 6 months after the injury shows case group (67%) have better prognosis then the control group (35%). There is 32% difference between case group and control groups (P< 0.05).
Conclusion：Patient underwent brain tissue oxygen monitoring system and intracranial pressure monitoring system to keep to continuously monitoring all parameters to maintain pulmonary function have better results on reduction of mortality rate and improved functional outcome

並列關鍵字

brain tissue oxygen monitoring system

參考文獻

5. Anuj Bhatia, Arun Kumar Gupta. Neuromonitoring in the intensive

13. Valadka, Alex B, Gopinath, Shankar P, Contant Charles F, Uzura Masahiko, Robertson Claudia S. Relationship of brain tissue PO2 to outcome after severe head injury. Neurologic Critical Care.

4. Campbell Stewart, Iain Haitsma, Zsolt zador, Claude Hemphill, Diane

12. Koichi Kurihara, Azusa Kikukawa, Asao Kobayashi. Cerebral

1. Jamshid Ghajar. Traumatic brain injury. Journal of Neurotrauma.