重型脑创伤患者脑细胞间液甘油浓度研究

Extracellular glycerol in patients with severe traumatic brain injury

目的研究重型脑创伤后影响脑细胞间液甘油(Gly)浓度变化的因素。方法连续监测53例重型颅脑创伤患者近损伤区脑细胞间液Gly浓度和局部脑血流(CBF),同时监测颅内压(ICP)及脑灌注压(CPP)。选择每小时CPP和CBF的最小值及ICP的最大值与该小时的Gly浓度匹配。根据局部CBF、ICP、CPP及预后将所有Gly样品分组。结果(1)Gly、CCP及CBF与预后的关系:与中残或重残组比较,植物生存或死亡组患者Gly显著增高而CCP及CBF显著降低(P<0.05);与恢复良好组比较,中残或重残组Gly显著增高而CCP及CBF显著降低(P<0.05)。(2)ICP,CCP,CBF对Gly的影响:ICP>15mmHg组、CCP<70mmHg组及CBF<50AU分别比ICP<15mmHg组、CCP>70mmHg及CBF50￣150AU组Gly浓度显著增高(P<0.01)。(3)病理类型和Gly浓度的关系:弥漫性轴索损伤Gly浓度最高,比硬膜外血肿及硬膜下血肿显著增高(P<0.05),但与脑挫裂伤患者无显著差异。结论Gly浓度可以反映原发和继发性脑损伤的严重程度,是细胞膜降解和脑缺血的可靠指标。

Objective To study the factors affecting extracellular glycerol （Gly） in patients with severe traumatic brain injury. Methods The extracellular Gly in the perilesion and CBF （cerebral blood flow） in 53 patients with severe traumatic brain injury were consecutively detected and intracranial pressure （ICP） and cerebral perfusion pressure （CPP） were monitored simultaneously. The minimum of hourly CCP and CBF and the maximum of hourly ICP levels were matched with hourly Gly. Gly values were divided on ICP（〈15 mm Hg or 〉15 mm Hg）, CCP（〈70 mm Hg or 〉70 mm Hg）, CBF（〈50 AU or 50-150 AU） and outcome （the death or the persistent vegetative state group, the severe or moderate disability group, and the good recovery group）. Results （1） Relationships between outcome and Gly, CBF and CCP： In comparison with the severe or moderate disability group, Gly of the persistent vegetative state or death group was significantly increased, but CBF and CCP were significantly decreased; In comparison with the good recovery, Gly of the severe or moderate disability group was significantly increased, but CBF and CCP were significantly decreased. （2） Effect ofICP, CBF and CCP on Gly： Gly ofICP〉15 mm Hg group, CCP〈70 mm Hg group and CBF〈50 AU group was respectively higher than ICP〈15 mm Hg group, CCP〉70 mm Hg group and CBF 50-150 AU group.（3）The mean Gly in patients with diffuse axial injury was significantly higher than the levels in patients with epidural hematoma or subdural hematoma, but the Gly of patients with diffuse axial injury was not significantly increased when compared with those in patients with contusion. Conclusion Gly is a marker for membrane phosphlipid degradation and ischaemia, which reflects the severity of primary or secondary insult.