目的 探讨亚低温治疗期间动脉二氧化碳分压(PaCO2)波动程度对重型颅脑创伤(sTBI)患儿短期预后的影响.方法 回顾性分析2018年1月至2023年6月山东大学齐鲁医院急诊神经外科收治的51例sTBI患儿的临床资料.所有患儿在亚低温治疗期间均接受早期PaCO2管控,行动态动脉血气监测和经颅多普勒超声(TCD)监测,并根据TCD结果设定PaCO2的目标值,通过调节潮气量、呼吸频率确定分钟通气量的范围.根据每例患儿亚低温治疗期间所有PaCO2值的标准差(s)进行分组,s值≤5 mm Hg(1 mm Hg=0.133 kPa)为PaCO2波动较小组(19例),s值＞5 mm Hg为PaCO2波动较大组(32例).对比两组患儿的亚低温治疗时长、住院时长、术后脑梗死的发生率、血神经元特异性烯醇化酶(NSE)最高值、出院时和出院后6个月格拉斯哥昏迷评分(GCS)等的差异.患儿出院后6个月接受门诊或电话随访.采用Pearson相关性分析方法分析患儿PaCO2的s值与出院后6个月GCS的相关性.结果 PaCO2波动较小组与PaCO2波动较大组患儿年龄、性别分布、入院时GCS的差异均无统计学意义(均P＞0.05).与PaCO2波动较大组比较,PaCO2波动较小组患儿的亚低温治疗时长[(97.3±11.3)h 对比(108.2±12.5)h]、住院时长[(16.8±3.8)d 对比(18.9±3.3)d]均较短,出院时GCS[(9.4±1.1)分对比(8.3±1.3)分]、出院后6个月GCS[(13.6±1.5)分对比(10.8±1.8)分]均较高(均P＜0.05).两组患儿术后NSE最高值和脑梗死发生率的差异均无统计学意义(均P＞0.05).患儿动脉血PaCO2的s值与出院后6个月GCS呈负相关(r=-0.66,P＜0.001).结论 亚低温治疗期间动脉PaCO2波动小有利于缩短sTBI患儿的亚低温治疗时长及住院时长,并且稳定的PaCO2与良好的短期预后相关.
Effect of arterial partial pressure of carbon dioxide fluctuation on short-term prognosis of children with severe traumatic brain injury during hypothermia treatment
Objective To investigate the effect of arterial partial pressure of carbon dioxide(PaCO2)fluctuation on short-term prognosis of children with severe traumatic brain injury(sTBI)during mild hypothermia treatment.Methods We collected and analyzed the clinical data of 51 children with sTBI admitted to Department of Emergency Neurosurgery in Qilu Hospital of Shandong University from January 2018 to June 2023.All children received PaCO2 control during hypothermia treatment,dynamic arterial blood gas monitoring and transcranial Doppler ultrasound(TCD)monitoring in initial treatment,and the target value of PaCO2 was set according to TCD results,and the range of minute ventilation was determined by adjusting tidal volume and respiratory rate.According to the standard deviation(s)of all PaCO2 values during mild hypothermia treatment of each child,all cases were divided into two groups,namely,the PaCO2 fluctuation small group(s≤5 mm Hg,1 mm Hg=0.133 kPa,19 cases)and large group(s＞5 mm Hg,32 cases).Then,we compared the duration of mild hypothermia treatment,total length of hospital stay,incidence of postoperative cerebral infarction,highest value of blood neuron specific enolase(NSE),Glasgow Coma Score(GCS)at discharge,and GCS at 6 months follow-up between the two groups.Patients received out-patient or telephone follow-up at 6 months after discharge.Pearson correlation analysis was used to analyze the correlation between the s value of PaCO2 and GCS value at 6 months.Results There were no significant differences in age,gender distribution and admission GCS between two groups(all P＞0.05).Compared with the PaCO2 fluctuation large group,the duration of mild hypothermia treatment(97.3±11.3 h vs.108.2±12.5 h)and the duration of hospitalization(16.8±3.8 d vs.18.9±3.3 d)in the small fluctuation group were shorter,discharge GCS(9.4±1.1 points vs.8.3±1.3 points)and 6 months follow-up GCS(13.6±1.5 points vs.10.8±1.8 points)were higher(all P＜0.05).There was no significant difference in maximum value of NSE or incidence of cerebral infarction between the two groups(both P＞0.05).There was a negative correlation between s value of arterial PaCO2 and GCS value at 6 months follow-up(r=-0.66,P＜0.001).Conclusion The small fluctuation of arterial PaCO2 in children with sTBI during mild hypothermia is conducive to shortening the time of mild hypothermia treatment and total length of hospital stay,and stable arterial PaCO2 is associated with good short-term prognosis.
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