亚低温治疗颅脑创伤患者颅内生化代谢动态研究

Energy metabolism after traumatic brain injury using clinical microdialysis and hypothermia treatment

目的应用微透析技术研究了24例颅脑创伤患者脑细胞间液中葡萄糖(Glu)、乳酸(Lac)、丙酮酸(Pyru)、甘油(Gly)、乳酸/葡萄糖比值(L/G)和乳酸/丙酮酸比值(L/P)的变化规律以及亚低温治疗的影响。方法将微透析导管分别插入患者脑创伤病灶半暗带区、相对正常脑组织区和腹部皮下组织,收集微透析液,灌流速度为0.3μl/min。1管透析液/h。平均收集时间为67.37±21.20h;收集的透析液用生化分析仪测定Glu、Lac、Pyru和Gly。结果(1)亚低温治疗较常温治疗可明显降低患者脑创伤病灶半暗带区GLY,明显升高L/P比值, 而Glu、Lac、Pyru、L/G与常温组无显著性差异;(2)亚低温治疗较常温治疗能显著降低相对正常的脑组织Glu、Lac含量和L/P比值,但对Pyru、L/G、Gly较常温组无显著性差异;(3)亚低温治疗较常温治疗可显著提高Glu含量,降低腹部组织Lac、Gly含量和L/G、L/P的比值,但对Pyru含量无明显调节作用。结论微透析技术提供了一种实时监测颅脑创伤患者脑和皮下组织细胞间液生化指标的手段,亚低温治疗能预防患者近损伤区细胞膜的进一步降解,对未受伤的脑组织和腹部组织具有更好的保护作用,从而防止继发性损害。

Objective To study the change of cerebral extracellular chemical marker (Glucose, Lactate, Pyruvate, Glycerol and the ratio of Lactate/Glucose, Lactate/Pyruvate) of traumatic brain injury in 24 patients using the clinical microdialysis, and to evaluate the effects of hypothermia. Methods Catheters for microdialysis were punctured into the semi-dark band in the cerebral traumatic foci, relatively normal brain tissue and/or abdominal subcutaneous tissue respectively to collect the fluid . The perfusion rate was 0.3μl/min and the fluid was collected each hour. The average collected time was 67.37±21.20h. All fluid was analyzed using the CMA microdialysis analyzer for examining the values of the four markers. Results 1. The concentration of Glu and ratio of L/P were decreased distinctly and the content of Lac and Gly were not changed in the semi-dark band in the cerebral traumatic foci by hypothermia treatment. 2. The content of Lac, Pyru, Gly and the ratio of Lac/Pyru were remarkably decreased and the concentration of Glu did not changed in the cerebral extracellular of relatively normal brain tissue by hypothermia treatment.3. The content of Lactate and ratio of Lac/Glu, Lac/Pyru were distinctly decreased and the concentration of Glu, Pyru and Gly were not changed in abdominal subcutaneous tissue by hypothermia treatment. Conclusions The clinical microdialysis technique provided a means to monitor extracellular chemical markers in the brain and subcutaneous tissue. Hypothermia treatment is of protective action to the uninjured tissue of brain and abdomen rather better than the injured tissue.