Preliminary Study On The Monitoring Of Regional Cerebral Oxygen Saturation After Severe Brain Trauma

Objective: To investigate the changes and significance of regional cerebral oxygen saturation(rScO2) after severe brain trauma, the changes of rScO2 and intracranial pressure(ICP) after treatment with different mannitol dosage and make a better use of mannital.Methods: 1. Twenty-nine comatose patients admitted to our hospital after severe brain trauma were given continuously monitoring of regional cerebral oxygen saturation(rSc02) by near-infrared spectroscopy(NIRS). Arterial oxygen saturation(SaO2), pulse oxygen saturation(SpO2), mean arterial blood pressure(MAP), intracranial pressure(ICP) and cerebral perfusion pressure(CPP) were monitored at ttie same time.2. Twenty patients experiencing operations after severe brain trauma were treated with 125ml or 250ml mannitol respectively (one day's total dose was same) and given continuously monitoring of rScO2 by NIRS, when ICP was below 30 mmHg. ICP of those patients was monitored simultaneously.Results: 1. rScO2 reduced dramatically in all patients after brain trauma. In 23 survivals, rScO2 went up shortly after operations, then declined for various duration, at last it restored gradually with the normalization of ICP. In 6 dead cases, rScO2 reduced continuously, however, SpO2, SaO2, MAP showed no significant change before patientsdied.2. The rScO2 changed and reached peak value much earlier than ICP. When ICP was below 25 mmHg, normal ICP and normal rScO2 could be kept longer in cases treated with mannitol of 125ml than those treated with 250ml (p<0.01) . When ICP was between 25 mmHg and 30 mmHg, ICP below 20 mmHg and normal rScO2 could be kept longer in cases treated with mannitol of 125ml than those tree ted with 250ml (p < 0.01 ) .Preliminary Study on the Monitoring of Regional Cerebral Oxygen Saturation after Severe Brain Trauma AbstractConclusions: rScC>2 can reflect cerebral oxygen metabolism accurately after severe brain trauma. Montoring rScCh is valuable in judging prognosis and guiding treatment. rScC>2 was a more sensitive index than ICP in detection of brain anoxia and ischemia. When ICP was less than 30 mmHg, brain edema could be effectively relieved with more frequent usage of mannitol.