Persistently low extracellular glucose correlates with poor outcome 6 months after human traumatic brain injury despite a lack of increased lactate: A microdialysis study
Persistently low extracellular glucose correlates with poor outcome 6 months after human traumatic brain injury despite a lack of increased lactate: A microdialysis study
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DOI：
10.1097/01.wcb.0000076701.45782.ef
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发表时间：
2003-07-01
影响因子：
6.3
通讯作者：
Hovda, DA
中科院分区：
文献类型：
--
作者：
Vespa, PM;McArthur, D;Hovda, DA
脑外伤后葡萄糖脑代谢紊乱反映在细胞外葡萄糖水平的变化上。作者假设创伤后细胞外葡萄糖水平的降低不是由于缺血引起的，而是与预后不良有关。对30例外伤性脑损伤患者进行脑内微透析、脑电图、脑组织氧水平及颈静脉氧饱和度测定。葡萄糖，乳酸水平。每小时分析一次丙酮酸、谷氨酸和尿素。对每位患者进行6个月格拉斯哥结局量表延长（GOSe6）评分。在由正电子发射断层扫描确定的葡萄糖利用增加的区域，细胞外葡萄糖浓度小于0.2 mmol/l。在损伤后第0 ~ 7天，每天19% ~ 30%的小时样本的细胞外葡萄糖值小于0.2 mmol。葡萄糖水平的短暂性降低发生在电痉挛和脑灌注压和颈静脉氧饱和度的非缺血性降低。在大多数低糖样品中，谷氨酸水平升高，但乳酸/丙酮酸比值并不表明局灶性缺血。终末期疝导致葡萄糖减少，乳酸/丙酮酸比值增加，但乳酸浓度不单独增加。GOSe6评分与持续低血糖水平、早期低血糖水平和低乳酸/葡萄糖比以及总体乳酸/葡萄糖比相关。这些结果表明，创伤性脑损伤后细胞外葡萄糖水平通常会降低，并与预后不良有关，但与缺血无关。
Disturbed glucose brain metabolism after brain trauma is reflected by changes in extracellular glucose levels. The authors hypothesized that posttraumatic reductions in extracellular glucose levels are not due to ischemia and are associated with poor outcome. lntracerebral microdialysis, electroencephalography, and measurements of brain tissue oxygen levels and jugular venous oxygen saturation were performed in 30 patients with traumatic brain injury. Levels of glucose, lactate. pyruvate, glutamate, and urea were analyzed hourly. The 6-month Glasgow Outcome Scale extended (GOSe6) score was assessed for each patient. In regions of increased glucose utilization defined by positron emission tomography, the extracellular glucose concentration was less than 0.2 mmol/l. Extracellular glucose values were less than 0.2 mmol during postinjury days 0 to 7 in 19% to 30% of hourly samples on each day. Transient decreases in glucose levels occurred with electrographic seizures and nonischemic reductions in cerebral perfusion pressure and jugular venous oxygen saturation. Glutamate levels were elevated in the majority of low-glucose samples, but the lactate/pyruvate ratio did not indicate focal ischemia. Terminal herniation resulted in reductions in glucose with increases in the lactate/pyruvate ratio but not in lactate concentration alone. GOSe6 scores correlated with persistently low glucose levels, combined early low glucose levels and low lactate/glucose ratio, and with the overall lactate/glucose ratio. These results suggest that the level of extracellular glucose is typically reduced after traumatic brain injury and associated with poor outcome, but is not associated with ischemia.