Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries.
Continuous monitoring of cerebral substrate delivery and clearance: initial experience in 24 patients with severe acute brain injuries.
复制标题
连续监测脑基质输送和清除：24 名严重急性脑损伤患者的初步经验。
DOI：
10.1097/00006123-199711000-00011
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发表时间：
1997
期刊：
影响因子：
4.8
通讯作者：
Bullock,R
中科院分区：
文献类型：
--
作者：
Zauner,A;Doppenberg,EM;Woodward,JJ;Choi,SC;Young,HF;Bullock,R
目的：当前严重人类头部损伤的神经监测技术常常无法检测出临床恶化的原因。现在可以使用传感器来连续监测大脑的氧张力、二氧化碳张力和 pH 值。在这项研究中，脑组织氧张力被用来区分有脑缺血风险的患者并预测结果。方法：将多参数传感器连同标准脑室造口导管和微透析探针一起插入 24 名患者的脑组织中。通过高压液相色谱法测量每小时透析液样品中的乳酸和葡萄糖。 结果：恢复良好的患者 (n = 8) 的平均脑氧分压为 39±4 mm Hg，脑二氧化碳分压 (PCO 2) 为 50±8 mm Hg，脑 pH 为 7.14±0.12。中度至重度残疾患者（n = 6）的平均脑氧分压为31±5 mm Hg，脑PCO 2 为47±2 mm Hg，脑pH为7.11±0.12。死亡或保持植物人状态的 10 名患者的平均脑氧分压为 19±8 mm Hg，脑 PCO 2 为 64±21 mm Hg，脑 pH 为 6.85±0.41。脑循环停止或脑死亡后，持续观察到平均脑 PCO 2 水平为 90 至 150 mm Hg。与脑氧张力相比，透析液乳酸和葡萄糖与结果的相关性不太明显。所有患者的透析液葡萄糖均极低，大多数死亡患者的透析液葡萄糖为零。结论：脑氧分压、脑二氧化碳分压和脑 pH 测量，以及用于葡萄糖和乳酸分析的微透析探针，可以通过更全面地了解影响脑代谢的动态因素来优化昏迷神经外科患者的管理。
OBJECTIVE:Current neuromonitoring techniques in severe human head injury often fail to detect the causes of clinical deterioration. A sensor is now available for continuous monitoring of brain oxygen tension, carbon dioxide tension, and pH values. In this study, brain tissue oxygen tension was used to differentiate patients at risk for brain ischemia and to predict outcome.METHODS:The multiparameter sensor was inserted into brain tissue, along with a standard ventriculostomy catheter and a microdialysis probe, in 24 patients. Lactate and glucose were measured by high-pressure liquid chromatography in hourly dialysate samples.RESULTS:Patients who experienced a good recovery (n= 8) sustained a mean brain partial oxygen pressure of 39±4 mm Hg, brain partial carbon dioxide pressure (PCO 2) of 50±8 mm Hg, and a brain pH of 7.14±0.12. Patients with moderate to severe disability (n= 6) sustained a mean brain partial oxygen pressure of 31±5 mm Hg, brain PCO 2 of 47±2 mm Hg, and a brain pH of 7.11±0.12. Ten patients who died or remained vegetative sustained a mean brain partial oxygen pressure of 19±8 mm Hg, a brain PCO 2 of 64±21 mm Hg, and a brain pH of 6.85±0.41. Mean brain PCO 2 levels of 90 to 150 mm Hg were consistently observed after cerebral circulatory arrest or brain death. Dialysate lactate and glucose were less clearly correlated to outcome than brain oxygen tension. Dialysate glucose was extremely low in all patients and zero in most patients who died.CONCLUSION:Brain oxygen pressure, brain carbon dioxide pressure, and brain pH measurements, as well as a microdialysis probe for glucose and lactate analysis, may optimize the management of comatose neurosurgical patients by allowing a fuller understanding of the dynamic factors affecting brain metabolism.