近红外光对重型颅脑损伤患者无创脑监测的临床意义

黄纯 周和平 王绍波 钱志余 施正生

摘   要：目的  探討近红外光谱技术（NIRS）在重型颅脑损伤患者治疗过程中实时无创脑监测的可行性。方法  采用回顾性病例研究分析2017年12月～2018年6月我院神经外科收治的25例重型颅脑损伤患者临床资料，使用强生codman颅内压监护仪及美国ISS公司的NIR Tissure Oximeter系统近红外光谱分析仪持续监测术后7 d相关指标（约化散射系数、颅内压、脑灌注压、平均动脉压），分析各指标间的相关性;按照患者预后GOS评分分为五组：第1组（1分，4例）;第2组（2分，9例）;第3组（3分，4例）;第4组（4分，4例）;第5组（5分，4例），分别比较各组术后第1～7天的μ's。结果  μ's与ICP呈显著负相关（r=-0.973，P<0.05），μ's与CPP呈显著正相关（r=0.675，P<0.05）;μ's与MAP无明显相关性（r=0.214，P>0.05）;不同预后患者，其约化散射系数测量值差异具有统计学意义（P<0.05）;从数值上分析，预后较好组，其约化散射系数相对较大;患者术后时间效应分析，对不同组别进行两两比较分析，约化散射系数测量值差异具有统计学意义（P<0.05）;随着术后时间的推移，约化散射系数呈上升趋势;时间与组别交互作用，差异无统计学意义（P>0.05）。结论  近红外光谱技术在无创脑监测领域有着重要的价值，与有创颅内压监测结果具有良好的一致性，为评估患者预后提供可靠的依据。

关键词：近红外光谱技术;约化散射系数μ's; 脑灌注;颅内压;平均动脉压;

中图分类号：R651.1+5                                文献标识码：A                              DOI：10.3969/j.issn.1006-1959.2018.24.016

文章编号：1006-1959（2018）24-0063-04

Abstract：Objective  To explore the feasibility of near-infrared spectroscopy （NIRS） for real-time non-invasive brain monitoring in patients with severe craniocerebral injury. Methods  A retrospective case study was conducted to analyze the clinical data of 25 patients with severe craniocerebral injury admitted to our hospital from December 2017 to June 2018. The Johnson & Johnson codman intracranial pressure monitor and the NIR Tissure Oximeter system of ISS USA were used. Near-infrared spectroscopy analyzer continuously monitored the relevant indicators （reduced scattering coefficient， intracranial pressure， cerebral perfusion pressure， mean arterial pressure） at 7 d postoperatively， and analyzed the correlation among the indicators. According to the prognosis GOS score， the patients were divided into five groups： Group 1 （1 point， 4 cases）; Group 2 （2 points， 9 cases）; Group 3 （3 points， 4 cases）; Group 4 （4 points， 4 cases）; Group 5 （5 points） ， 4 cases）， respectively， compared the μ's from the 1st to the 7th day after surgery. Results  μ's was significantly negatively correlated with ICP （r=-0.973， P<0.05）. There was a significant positive correlation between μ's and CPP （r=0.675， P<0.05）. There was no significant correlation between μ's  and MAP （r=0.214， P>0.05）; the difference of the measured scattering coefficient of the patients with different prognosis was statistically significant （P<0.05）; from the numerical analysis， the prognosis group was relatively large， and the reduced scattering coefficient was relatively large; The postoperative time effect analysis of the patients was carried out by comparing the two groups. The difference of the measured values of the reduced scattering coefficient was statistically significant （P<0.05）. With the postoperative time， the reduced scattering coefficient showed an upward trend. Time and group interaction， the difference was not statistically significant （P>0.05）. Conclusion  Near-infrared spectroscopy has important value in the field of non-invasive brain monitoring. It has good consistency with the results of invasive intracranial pressure monitoring， and provides a reliable basis for evaluating the prognosis of patients.