Continuous versus intermittent cerebrospinal fluid drainage after severe traumatic brain injury in children: effect on biochemical markers.
Continuous versus intermittent cerebrospinal fluid drainage after severe traumatic brain injury in children: effect on biochemical markers.
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儿童严重创伤性脑损伤后连续与间歇性脑脊液引流：对生化标志物的影响。
DOI：
10.1089/neu.2004.21.1113
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发表时间：
2004
影响因子：
4.2
通讯作者：
Kochanek,PatrickM
中科院分区：
文献类型：
--
作者：
Shore,PaulM;Thomas,NealJ;Clark,RobertSB;Adelson,PDavid;Wisniewski,StephenR;Janesko,KeriL;Bayir,Hulya;Jackson,EdwinK;Kochanek,PatrickM
脑脊液（CSF）引流通常用于治疗严重创伤性脑损伤（TBI），可连续或间歇地对颅内压（ICP）升高做出反应。关于脑脊液引流方法对成人或儿童TBI的生物化学、病理生理学或结局的影响的研究很少。在先前报道了严重TBI后CSF中多种损伤或修复标志物增加的基础上，我们选择直接评估CSF引流方法对引流的CSF的生化和量以及ICP的影响。我们假设这些标记物的浓度在连续引流与间歇引流的CSF中相似。我们比较了脑脊液中神经元损伤标志物的水平，（神经元特异性烯醇化酶，[NSE]），神经胶质损伤（s100 B），炎症（白细胞介素-6 [IL-6]），和再生（血管内皮生长因子[VEGF]）（通过ELISA测量）来自19名严重受伤儿童的80份CSF样本，其CSF连续引流（n = 13）与间歇引流（n = 6）作为两个机构的标准护理的一部分。与连续CSF引流相比，CSF间歇引流与CSF中NSE、s100 B、IL-6和VEGF浓度的两倍增加相关（p <0.05），并且CSF清除量约为连续引流的一半（p = 0.002）。然而，这些生化物质的最终消除（浓度×体积）不受排水方法的影响。接受持续引流治疗的患者的平均ICP低于接受间歇引流治疗的患者（13.6 ± 0.69 vs. 21.8 ± 0.95 mm Hg，p <0.0001）。我们的结论是，脑脊液引流的方法大大影响浓度的脑脊液标记物后TBI，并可能影响ICP。在判读时必须考虑方法对CSF标志物浓度的影响
Drainage of cerebrospinal fluid (CSF) is routinely used in the treatment of severe traumatic brain injury (TBI), either continuously or intermittently in response to increases in intracranial pressure (ICP). There has been little study of the effect of CSF drainage method on the biochemistry, pathophysiology or outcome of TBI in adults or children. Having previously reported that a variety of markers of injury or repair increase in CSF after severe TBI, we chose to evaluate directly the effect of CSF drainage method on the biochemistry and volume of CSF drained as well as ICP. We hypothesized that concentrations of these markers would be similar in CSF drained continuously vs intermittently. We compared CSF levels of markers of neuronal injury (neuron specific enolase, [NSE]), glial injury (s100B), inflammation (interleukin-6 [IL-6]), and regeneration (vascular endothelial growth factor [VEGF]) (measured by ELISA) in 80 CSF samples from 19 severely injured children whose CSF was drained continuously (n = 13) versus intermittently (n = 6) as part of standard care in two institutions. Compared to continuous CSF drainage, intermittent drainage of CSF was associated with twofold greater CSF concentrations of NSE, s100B, IL-6 and VEGF (p < 0.05) and with about half the volume of CSF removal than continuous drainage (p = 0.002). The resulting elimination (concentration × volume) of these biochemicals, however, was not influenced by drainage method. Patients treated with continuous drainage had lower mean ICPs than those with intermittent drainage (13.6 ± 0.69 vs. 21.8 ± 0.95 mm Hg, p < 0.0001). We conclude that the method of CSF drainage greatly affects concentrations of CSF markers after TBI and may influence ICP. The influence of method on CSF marker concentration must be kept in mind when interpreting
头部受伤患者的 CSF 和 ECF 谷氨酸浓度。
DOI：
10.1007/978-3-7091-6415-0_4
发表时间：
1999
期刊：
Acta neurochirurgica. Supplement
影响因子：
--
作者：
T. Yamamoto;S. Rossi;Michael F. Stiefel;E. Doppenberg;A. Zauner;Ross Bullock;Anthony Marmarou
通讯作者：
Anthony Marmarou
影响因子：
8
作者：
Berger, RP;Pierce, MC;Kochanek, PM
通讯作者：
Kochanek, PM