Is There Any Association Between Cerebral Vasoconstriction/Vasodilatation and Microdialysis Lactate to Pyruvate Ratio Increase?
Is There Any Association Between Cerebral Vasoconstriction/Vasodilatation and Microdialysis Lactate to Pyruvate Ratio Increase?
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DOI：
10.1007/s12028-013-9821-6
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发表时间：
2013-08-01
影响因子：
3.5
通讯作者：
Hu, Xiao
中科院分区：
文献类型：
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作者：
Asgari, Shadnaz;Vespa, Paul;Hu, Xiao
虽然脑损伤患者的乳酸/丙酮酸比值（LPR）异常升高可能提示脑缺血，但导致LPR升高的主要因素仍存在争议，本文通过数据分析实验来验证脑血管舒张/收缩与LPR升高是否存在相关性。我们研究了从30名严重创伤性脑损伤（TBI）患者中收集的平均间隔为1.3小时的4，316个微透析数据样本。使用5个样本的移动时间窗口自动识别LPR增加事件。一种新的脉冲形态模板匹配（PMTM）算法应用于相应患者的颅内压（ICP）数据，以评估在识别的LPR增加事件期间脑血管舒张和血管收缩的发生。对脑血管收缩/血管舒张与LPR升高之间的相关性进行了分析，结果显示，尽管半数以上的LPR升高事件与任何检测到的脑血管收缩/血管舒张无关，但当与LPR升高相关的血管变化发生时，这种血管变化更可能是以血管收缩而不是血管舒张的形式发生的。同样对于少数血管收缩发作次数占优势的受试者，观察到血管收缩与LPR升高之间存在因果关系（血管收缩先于LPR增加）。使用连续颅内压监测和我们的脉搏形态模板匹配（PMTM）该算法可能有助于梳理创伤性脑损伤患者的罪犯脑血管变化是否先于代谢危象，从而指导治疗这种情况。
Although abnormally high Lactate/Pyruvate ratio (LPR) could indicate cerebral ischemia for brain injury patients, there is a debate on what is primary factor responsible for LPR increase.A data analysis experiment is taken to test whether any association between cerebral vasodilatation/vasoconstriction and LPR increase exists. We studied 4,316 microdialysis data samples collected in an average interval of 1.3 h from 30 severe traumatic brain injury (TBI) patients. The LPR increase episodes were automatically identified using a moving time-window of 5 samples. A novel pulse morphological template matching (PMTM) algorithm was applied to the intracranial pressure (ICP) data of the corresponding patients to assess the occurrence of cerebral vasodilatation and vasoconstriction during the identified LPR increase episodes. Several analyses were performed to evaluate the association between cerebral vasoconstriction/vasodilatation and LPR increase.Results revealed that although more than half of the LPR increase episodes are not associated with any detected cerebral vasoconstriction/vasodilatation, when a vaso-change happens in association of LPR increase, it is more likely that this vaso-change is in the form of vasoconstriction rather than vasodilatation. Also for few subjects with dominant number of vasoconstriction episodes, a causality relationship between vasoconstriction and LPR increase were observed (vasoconstriction precedes LPR increase).Using continuous intracranial pressure monitoring and our pulse morphological template matching (PMTM) algorithm could be potentially helpful in teasing out whether culprit cerebral vascular changes precede metabolic crisis for traumatic brain injury patients and hence guiding the management of this condition.