摘要
目的 探讨危重病患儿脑脊液 (CSF)和血液气体及酸碱含量变化及其与疾病的关系。方法 6 0例危重病患儿 [危重评分 <70分和 (或 )Glasgow昏迷评分≤ 8分 ]中 ,中枢神经系统 (CNS)疾病组 34例 ,非CNS疾病组 2 6例。同步检测 6 0例急性期CSF和动脉血pH、PO2 、PCO2 、HCO-3 等含量。结果 CSF中pH、PO2 、PCO2 、HCO-3 与血液相应指标变化呈正相关 (r =0 .348～ 0 .872 ,P <0 .0 5或0 .0 1)。CNS疾病组 ,CSF中pH、PO2 、PCO2 、HCO-3 分别为 7.10、5 2 .7mmHg、5 8.8mmHg和 15 .6 2mmol L ,与动脉血指标比较差异有显著性 (P <0 .0 1) ,其中CSF的PO2 比动脉血PO2 (平均 78.8mmHg)低 2 6 .3mmHg ;非CNS疾病组CSF的pH、PO2 、PCO2 、HCO-3 分别为 7.0 4、5 5 .4mmHg、5 9.2mmHg和16 .7mmol L ,与动脉血指标比较差异无显著性 (P >0 .0 5 )。两组疾病CSF中各指标比较差异无显著性(P >0 .0 5 )。结论 危重病患儿伴随有CSF酸碱指标的显著变化 ,并与血气指标呈正相关。当CNS疾病动脉血PO2 降低尚不明显时 ,脑组织可能已存在明显低氧状态。CSF气体及酸碱测定可对危重病患儿脑组织氧水平、酸碱状态的评估提供依据。
Objective Acid base and blood gas analysis is one of the important monitor methods in critical illness. The cerebrospinal fluid (CSF) analysis is better than the blood analysis on understanding the oxygen supply and acid base balance of central nervous system (CNS). However, little relevant information is available on children. The aim of this research is to study the changes and roles of acid base, oxygen and carbon dioxide (CO 2) pressures in CSF and arterial blood of critical illness in pediatric patients. Methods Sixty cases of pediatric critical illness were enrolled in the study. Thirty three cases were male and 27 female. The average age was 4.6 years. Thirty four cases were CNS disorders, and 26 cases were non CNS illness. The critical illness were defined by the pediatric critical patient score <70 and/or Glasgow coma score ≤8.The variable data, such as pH, PO 2, PCO 2 and HCO - 3 were synchronously measured in CSF and arterial blood in the acute phase of the illness. Results The data in CSF were positive correlated with those in blood in each group ( r =0.348 0.872, P <0.05 or P <0.01). pH, PO 2, PCO 2 and HCO - 3of CSF in CNS disorder group were 7.10, 52.7 mm Hg, 58.8 mm Hg and 15.6 mmol/L, respectively, which differed significantly from those of arterial blood ( P < 0.01). The PO 2 in CSF was 26.3 mm Hg and lower than that in arterial blood (average 78.8 mm Hg). In non CNS illness group, the pH,PO 2, PCO 2 and HCO - 3 in CSF were 7.04, 55.4 mm Hg, 59.2 mm Hg and 16.7 mmol/L, and no different from those in the blood ( P >0.05). There was no difference of the data in CSF between CNS disorder and non CNS disorder groups. Conclusion pH, PO 2, PCO 2 and HCO - 3in CSF changed significantly in both CNS disorder and non CNS disorder in critical illness, which showed a positive correlation with those in the arterial blood. The brain tissue may undergo remarkable hypoxia while there is no sign of hypoxemia in arterial blood in CNS critical illness. The detection of above data in CSF may assist the evaluation of the brain tissue oxygen supply and acid base balance in critical illness.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2000年第11期675-677,共3页
Chinese Journal of Pediatrics
关键词
危重病
脑脊髓液
酸碱平衡
血气分析
儿童
Critical illness
Cerebrospinal fluid
Acid base equilibrium
Blood gas analysis
Child
