Patterns of energy substrates during ischemia measured in the brain by microdialysis
Patterns of energy substrates during ischemia measured in the brain by microdialysis
复制标题
DOI：
10.1089/0897715041526195
复制
发表时间：
2004-07-01
影响因子：
4.2
通讯作者：
Robertson, CS
中科院分区：
文献类型：
--
作者：
Hlatky, R;Valadka, AB;Robertson, CS
本研究的目的是检查通过监测脑组织pO（2）（PbtO（2））确定的缺氧/缺血期间脑中葡萄糖、乳酸盐、丙酮酸盐和谷氨酸盐的微透析液浓度变化模式。特别令人感兴趣的是更好地理解通过微透析参数可以获得哪些额外的信息，这些信息不能从PbtO（2）中获得。研究了57名患有严重创伤性脑损伤的患者，他们放置了脑组织pO（2）（PbtO（2））和微透析探针。微透析探针用林格氏溶液以0.3穆尔/min灌注，并以1小时的间隔收集透析液。测量每个透析液样本中葡萄糖、丙酮酸、乳酸和谷氨酸的浓度。在PbtO（2）降至10 mm Hg以下的发作期间，检查微透析参数的变化。在监测期间，观察到10次组织缺氧/缺血发作，通过PbtO（2）降低至10 mm Hg以下进行鉴定。透析液葡萄糖浓度紧随PbtO（2）。透析液丙酮酸盐浓度变化较大，当PbtO（2）降至10 mm Hg以下时，某些患者的丙酮酸盐浓度会短暂升高。当PbtO（2）降至10 mm Hg以下时，透析液中乳酸盐浓度显著增加。仅当PbtO（2）降至极低水平时，透析液谷氨酸才显著升高。虽然PbtO（2）的变化提供了缺氧/缺血的最早迹象，但微透析测定提供了关于组织pO（2）降低对脑代谢的影响的额外信息，这可能有助于管理这些危重患者。
The purpose of this study was to examine the patterns of change in microdialysate concentrations of glucose, lactate, pyruvate, and glutamate in the brain during periods of hypoxia/ischemia identified by monitoring brain tissue pO(2) (PbtO(2)). Of particular interest was a better understanding of what additional information could be obtained by the microdialysis parameters that was not available from the PbtO(2). Fifty-seven patients admitted with severe traumatic brain injury who had placement of both a brain tissue pO(2) (PbtO(2)) and microdialysis probe were studied. The microdialysis probe was perfused with Ringer's solution at 0.3 muL/min and dialysate was collected at 1-h intervals. The concentration of glucose, pyruvate, lactate, and glutamate were measured in each dialysate sample. Changes in the microdialysis parameters were examined during episodes where the PbtO(2) decreased to below 10 mm Hg. Ten episodes of tissue hypoxia/ischemia identified by a decrease in PbtO(2) below 10 mm Hg were observed during the period of monitoring. The concentration of the dialysate glucose closely followed the PbtO(2). The dialysate pyruvate concentration was more variable and in some patients transiently increased as the PbtO(2) dropped below 10 mm Hg. The dialysate concentration of lactate was significantly increased as the PbtO(2) decreased to less than 10 mm Hg. Dialysate glutamate was significantly elevated only when PbtO(2) decreased to very low levels. Although changes in the PbtO(2) provided the earliest sign of hypoxia/ischemia, the microdialysis assays provided additional information about the consequences that the reduced tissue pO(2) has on brain metabolism, which may be helpful in managing these critically ill patients.