Cerebral metabolic effects of exogenous lactate supplementation on the injured human brain
Cerebral metabolic effects of exogenous lactate supplementation on the injured human brain
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DOI：
10.1007/s00134-013-3203-6
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发表时间：
2014-03-01
影响因子：
38.9
通讯作者：
Oddo, Mauro
中科院分区：
文献类型：
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作者：
Bouzat, Pierre;Sala, Nathalie;Oddo, Mauro
实验证据表明，乳酸在急性脑损伤后具有神经保护作用；然而，在人类身上缺乏数据。我们研究了外源性乳酸补充是否改善了创伤性脑损伤(TBI)患者的脑能量代谢。我们前瞻性地研究了连续15名重型脑损伤患者的脑微透析(CMD)、脑组织氧分压(PbtO(2))和颅内压(ICP)的监测。干预措施包括在颅脑损伤后早期静脉滴注高渗乳酸钠3h(旨在将全身乳酸水平提高到约5 mm ol/L)。我们检测了乳酸钠对神经化学(CMD乳酸、丙酮酸、葡萄糖和谷氨酸)、PbtO(2)和ICP的影响。伤后16小时开始治疗平均33+/-A。混合效应多水平回归模型显示，乳酸钠治疗可显著增加慢性阻塞性肺疾病患者的血乳酸[系数0.47mmoL/L，95%可信区间(CI)0.31~0.63mmoL/L]、丙酮酸[13.1(8.78~17.4mU/L)、血糖[0.1(0.04~0.16)mmoL/L；均P<0.01]。CmD谷氨酸[-0.95(-1.94~0.06)mmol/L，p=0.06]和颅内压[-0.86(-1.47~-0.24)mm Hg，p<；0.01]也随之降低。脑细胞外丙酮酸和葡萄糖利用率的增加，加上脑谷氨酸和颅内压的降低，表明高渗乳酸治疗对脑创伤后的脑代谢和血流动力学有有益的影响。
Experimental evidence suggests that lactate is neuroprotective after acute brain injury; however, data in humans are lacking. We examined whether exogenous lactate supplementation improves cerebral energy metabolism in humans with traumatic brain injury (TBI).We prospectively studied 15 consecutive patients with severe TBI monitored with cerebral microdialysis (CMD), brain tissue PO2 (PbtO(2)), and intracranial pressure (ICP). Intervention consisted of a 3-h intravenous infusion of hypertonic sodium lactate (aiming to increase systemic lactate to ca. 5 mmol/L), administered in the early phase following TBI. We examined the effect of sodium lactate on neurochemistry (CMD lactate, pyruvate, glucose, and glutamate), PbtO(2), and ICP.Treatment was started on average 33 +/- A 16 h after TBI. A mixed-effects multilevel regression model revealed that sodium lactate therapy was associated with a significant increase in CMD concentrations of lactate [coefficient 0.47 mmol/L, 95 % confidence interval (CI) 0.31-0.63 mmol/L], pyruvate [13.1 (8.78-17.4) mu mol/L], and glucose [0.1 (0.04-0.16) mmol/L; all p < 0.01]. A concomitant reduction of CMD glutamate [-0.95 (-1.94 to 0.06) mmol/L, p = 0.06] and ICP [-0.86 (-1.47 to -0.24) mmHg, p < 0.01] was also observed.Exogenous supplemental lactate can be utilized aerobically as a preferential energy substrate by the injured human brain, with sparing of cerebral glucose. Increased availability of cerebral extracellular pyruvate and glucose, coupled with a reduction of brain glutamate and ICP, suggests that hypertonic lactate therapy has beneficial cerebral metabolic and hemodynamic effects after TBI.