Multiparametric continuous monitoring of brain metabolism and substrate delivery in neurosurgical patients.
Multiparametric continuous monitoring of brain metabolism and substrate delivery in neurosurgical patients.
复制标题
神经外科患者脑代谢和底物输送的多参数连续监测。
DOI：
10.1080/01616412.1997.11740812
复制
发表时间：
1997
影响因子：
1.9
通讯作者：
Bullock,R
中科院分区：
文献类型：
--
作者：
Zauner,A;Doppenberg,E;Woodward,JJ;Allen,C;Jebraili,S;Young,HF;Bullock,R
大脑功能和组织完整性高度依赖于持续的氧气供应和二氧化碳的清除。有氧代谢是正常脑的主要能量来源，但在缺氧和缺血时，有时会出现乳酸积聚，这表明重型颅脑损伤后存在无氧糖酵解。目前的监测技术往往无法检测到这样的事件，这些事件可能会影响底物向受损大脑的输送。我们最近采用了一种使用单一传感器连续监测脑组织P02、PCO2、pH和温度的方法。多参数传感器通过一个新的三腔螺栓，以及一个标准的脑室造口导管和一个微透析探头插入脑组织。只要需要，该系统就会保持在适当的位置，但不会超过7天。所有读数都与临床参数和结果进行了比较。第一组20名患者，在校准和坚固固定后，使用新的螺栓可以获得稳定的测量结果。重型颅脑损伤患者在受伤后的头几个小时内脑氧水平低于25-30毫米汞柱。此后，可以看到两种模式。只要脑灌流压(CPP)保持在70 mm Hg以上，预后良好的患者脑氧合缓慢升高，Braln CO2降至正常值。然而，在那些继发性充血事件和不良结局的患者中，可以看到脑氧水平进一步下降到无氧水平(<；20毫米汞)。对于这些患者，可以看到脑部二氧化碳水平的降低和升高。脑死亡后，脑内二氧化碳浓度持续在90-150毫米汞柱之间。在所有疲劳症中，脑pH与脑CO2呈负相关。预后较差的患者脑糖和乳酸水平分别为639pM1-1±330和1642μM1-±788，而预后良好的患者脑糖水平为808μM1-1±321，乳酸水平为1001μM1-1±417。使用用于测量脑氧、二氧化碳、pH和温度的组合传感器以及用于葡萄糖和乳酸分析的微透析探头来扩展神经监控，通过允许更全面地了解影响大脑代谢的动态因素，可能会优化未来昏迷的神经外科患者的管理。[神经资源1997；19：265-273]
Brain function and tissue integrity are highly dependent on continuous oxygen supply and clearance of CO2. Aerobic metabolism is the major energy source to normal brain, however, during hypoxia and ischemia, lactate accumulation may sometimes be seen, indicating anaerobic glycolysis after severe head injury. Current monitoring techniques often fail to detect such events which can affect substrate delivery to the injured brain. We have recently adapted a method for continuous monitoring of brain tissue p02, pC02, pH and temperature, using a single sensor. The multiparameter sensor is inserted into brain tissue, via a new three lumen bolt, together with a standard ventriculostomy catheter and a microdialysis probe. The system has been left in place as long as needed, but never more than 7, days. All readings were compared to clinical parameters, and outcome. Stable measurements could be obtained in the first group of 20 patients, after calibration and rigid fixation, using the new bolt. Severely head injured patients had brain oxygen levels of less than 25-30 mmHg for the first hours, after injury. Thereafter two patterns could be seen. Patients with favorable outcome had a slow increase in brain oxygen, and braln CO2decreased to normal values, as long as the cerebral perfusion pressure (CPP) was kept above 70 mmHg. However, in those patients with secondary isc;;hemic events, and bad outcome, a further decline in brain oxygen to anaerobic levels (< 20 mmHg) was seen. For these patients, both decreased and increased brain CO2levels could be seen. Brain CO2levels of 90–150 mmHg were consistently seen after brain death. Brain pH was inversely related to brain CO2for all fatients. Brain glucose and lactate in patients with poor outcome were 639 pM 1-1± 330, and 1642 μM1-± 788, whereas patIents wIth good outcome had brain glucose levels of 808 μM1-1± 321 and lactate levels of 1001 μM1-1± 417. Extended neuromonitoring using a combined sensor for brain oxygen, CO2, pH and temperature measurements, as well as a microdialysis probe for glucose and lactate analysis may optimize the management of comatose neurosurgical patients in the future, by allowing a fuller understanding of dynamic factors affecting brain metabolism. [Neural Res 1997; 19: 265–273]