颅脑创伤患者血浆和脑脊液血管升压素的动态变化及意义

Dynamic change and clinical significance of the AVP level of serum and cerebrospinal fluid in patients with acute craniocerebral injury

目的 探讨颅脑创伤患者血浆和脑脊液血管升压素 (AVP)的动态变化及其临床意义。方法 将 36例中重度颅脑创伤患者按GCS和GOS评分分组 ,采用放射免疫RIA方法和渗透压测定仪对患者血浆和脑脊液中AVP、血浆和脑脊液渗透压和电解质进行动态检测 ,同时选择 30例外科手术患者作为对照。结果 颅脑创伤组血浆和脑脊液AVP明显高于对照组并与GCS评分有关。对照组血浆AVP术前与术后有显著性差异 ,GOS各分组间脑脊液AVP有显著性差异 ,AVP水平与脑脊液渗透压和颅内压相关 ;血浆AVP与血浆渗透压相关 ;Spearman相关性检验提示 ,相对低钠血症 ,血浆AVP变化较脑脊液AVP敏感 ;相对颅内压变化血浆渗透压较脑脊液渗透压敏感。结论 血浆和脑脊液中AVP可以通过不同环节和不同因素参与继发性脑损害的过程 ,脑脊液或血浆中的AVP可以通过不同环节和不同因素参与继发性脑损害的过程 ,脑脊液或血浆中的AVP与颅脑创伤损伤严重程度密切相关 ,可以作为判断伤情程度的客观指标 ;创伤患者预后越差 ,脑脊液中AVP浓度越高 ,测定颅脑创伤患者CSF中AVP水平比血浆中AVP更合适作为预后的判断指标 ,用来评估脑水肿严重程度和颅内压也较血浆中AVP敏感、准确。

ObjectiveTo investigate the dynamic change and clinical significance of the AVP level of serum and cerebrospinal fluid(CSF) in patients with acute craniocerebral injury.MethodsAccording to the GCS,GOS,36 cases were divided and AVP in serum and in CSP were assayed by RIA technique; osmolality concentration and electrolyte were assayed in clinical laboratory.30 surgical patients were taken for control group.ResultsAVP concentration of the serum and the CSF in patients were significantly higher than those of control group and were related to GCS.In control group, AVP of serum at the pre-operation was significantly different from that at the post-operation.Among every group of GOS,the CSF AVP concentration in patients was significantly different.There were positive correlation between the CSF AVP and ICP,between AVP in CSF and osmolality in CSF.AVP in serum and osmolality in serum were significantly negative correlation. The level of serum AVP were more accurate for estimating hyponatremia than that of CSF AVP, and serum AVP was more sensitive for evaluating ICP chang than CSF AVP by using Spearman correlation analysis.ConclusionAVP in serum or in CSF were concerned with the process of secondary brain injury,and both of them may be valuable to estimate the injury severity.The severer craniocerebral injury was, the worse the prognosis of patients were. The change of AVP level in CSF may be a beneficial to prognostic marker and is more sensitive than that in serum for evaluating the degree of brain edema or ICP.