重型脑损伤患者脑组织细胞外液成分的变化

Biochemical component changes of extracellular fluid in patients with severe traumatic head injury

目的 研究重型脑损伤患者的治疗结果与伤后早期脑组织细胞外液生化成分间的关系。 方法 对 4 5例格拉斯哥昏迷评分 (GCS) 3～ 8分的患者行脑组织微透析取样监测 10～ 96h ,测定葡萄糖、乳酸、丙酮酸浓度并计算乳酸 /葡萄糖和乳酸 /丙酮酸比值。全部患者在伤后 6个月行格拉斯哥预后评分 (GOS)。 结果 各项指标在GOS良好组、不良生存组和死亡组间差异有非常显著性意义 (P <0 .0 1) ,GOS与乳酸 /葡萄糖 (r=- 0 .75 6 ,P <0 .0 0 1)和乳酸 /丙酮酸 (r =- 0 .115 ,P =0 .0 4 2 )呈负相关 ,GOS与丙酮酸 (r=0 .5 71,P <0 .0 0 1)、葡萄糖 (r =0 .4 74 ,P <0 .0 0 1)和乳酸 (r =0 .4 80 ,P <0 .0 0 1)呈正相关。 结论 通过微透析监测脑细胞外液成分的变化 ,可以揭示创伤后脑组织的能量代谢特点并有助于判断患者的预后。

Objective To study relation between the biochemical component changes of extracellular fluid in the early stage post brain injury and the treatment outcome of patients with severe traumatic head injury (sTHI). Methods A total of 45 cases with Glasgow Coma Scale (GCS) for 3-8 scores were monitored for 10-96 hours by using intracranial microdialysis. Biochemical analyses of glucose (Glu),lactate (Lac),and pyruvate (Pyru) were performed by the Microdialysis Analyser CMA 600. Ratios of lactate/glucose (L/G) and lactate/pyruvate (L/P) were calculated and concentrations of glucose,lactate and pyruvate measured. Based on their GOS evaluated at the 6th month post-injury,the patients were divided into three groups,ie,Group A ( n =24,GCS score for 5),Group B ( n =9,GCS score for 2-4) and Group C ( n =12,GCS score for 1). Results There were obvious differences ( P <0.001) in regard of substrates or ratios in Groups A,B and C. GOS negatively correlated with L/G ( r =-0.756,P <0.001) and L/P ( r =-0.115,P = 0.042) ,but GOS positively correlated with Pyru ( r = 0.571 ,P <0.001),Glu ( r =0.474,P <0.001) and Lac ( r = 0.480 ,P <0.001). Conclusions Chemical component changes monitored by microdialysis technique can indicate the character of injured energy metabolism of brain tissues and is helpful for predicting the prognosis.