摘要
目的研究气管内吸引术 (endotrachealsuctioning ,ETS)对兔急性脑内血肿致颅内高压状态下脑氧代谢的影响及其意义。方法实验动物麻醉后行气管切开插管 ,呼吸机辅助呼吸 ,并随机分成两组 ,对照组 (n =10 )和颅内高压组 (n =10 ) ,利用微泵注射自体血法建立兔急性脑内血肿模型。行开放式气管内吸引术 ,吸引负压 10 .0kPa ,吸引时程 10s。分别于吸引前、中、后 15min内动态监测ICP、MAP、CPP变化 ,同时运用颈内静脉插管技术及外周血气分析观察SjvO2 、CEO2 、AVDO2 变化。结果两组动物ETS后ICP均有短暂升高 (P <0 .0 5 ) ,而MAP基本不变。颅内高压组ETS后即时SjvO2 下降至 76 .9± 5 .3% (P <0 .0 1) ,CEO2 、AVDO2 明显上升 (P <0 .0 1) ,CPP下降 (P <0 .0 5 )。结论颅内高压状态下进行开放式气管内吸引术可引起脑缺血、缺氧反应 ,而短暂的ICP升高并无特异性。因此 ,在ETS时需重视脑氧继发性损害 ,SjvO2 监测有助于早期发现脑缺血、缺氧。
Objectives To study the effect and significance of endotracheal suctioning on cerebral oxygenation during intracranial hypertention in a model of intracerebral hematoma in rabbits. Method The animals were intubated, mechanically ventilated, and randomly assigned to two groups. GroupⅠ( n =10) severed as controls and received no injury. GroupⅡ( n =10) were used to establish a model of intracerebral hematoma with injecting autologous blood. Opening ETS was applied at pressure of 10.0kPa for 10sec. By using a technique of jugular catheterization and analyzing blood gases, the changes in SjvO 2(oxygen saturation of jugular blood)?CEO 2(cerebral extraction of oxygen) and AVDO 2(cerebral arteriovenous difference of oxygen) were observed, and ICP?MAP?CPP were continuously monitored before and during the ETS protocol and for a maximum of 15minutes after the procedures.Result All the animals had transient elevations of ICP during ETS ( P <0.05), however, no significant changes in MAP. Immediately after ETS, SjvO 2 was greatly decreased to 76.9±5.3%( P <0.01),CEO 2 and AVDO 2 improved ( P <0.01) with a concomitant decrease in CPP( P <0.05) in GroupⅡ.Conclusion Opening ETS can negatively influence oxygenation during intracranial hypertention, whereas the ETS-induced increase in ICP may be no specialization. So we should attach importance to the secondary reduction in cerebral oxygentation during ETS, SjvO 2 monitoring will be helpful for detecting cerebral ischemia or hypoxia early.
出处
《护士进修杂志》
北大核心
2002年第6期412-414,共3页
Journal of Nurses Training
