Clinical application of neurochemical monitoring

神经化学监测的临床应用

• 批准号: 06671530
• 负责人: TATEISHI Akio
• 金额: $ 1.34万
• 依托单位: Yamaguchi University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (C)
• 财政年份: 1994
• 资助国家: 日本
• 起止时间: 1994 至 1995
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-06671530/
• 关键词: Cerebral resuscitation; Post-resuscitation encephalopathy; Head trauma; Microdialysis; Lactate; Nitric Oxide; Excitatory amino acid

Purpose ; to clinically introduce several biochemical indices, in addition to conventional electrophysiological monitoring, and thereby to detect the derangement of neural metabolic process upon which newly-developed therapies are to be focused.Subjects ; hypoxic encephalopathy, subarachnoid hemorrhage, head trauma (15 patients).Methods ; In hypoxic encephalopathy, oxygen saturation and lactate concentration in the jugular bulb blood were measured to assess the presence of anaerobic oxygen metabolism during relative hypoperfusion phase immediate post-resuscitation. In subarachnoid hemorrhage (SAH) complicated with cerebral vasospasm, the effect of mild hypothermia on excitotoxicity process was evaluated by measuring glutamate (Glu ; HPLC) and nitric oxide (NO2, NO3 ; capillary electrophoresis) levels in cerebrospinal fluid (CSF). In severely head-injured patients, Glu and NOx levels are measured in microdialysis perfusate.Results ; The concentration of lactate was greater in both arter … More ial and venous blood in non-survivors than in survivors. The arteriovenous difference of lactate was, however, not statistically different between survivors and non-survivors. The CSF Glu level was elevated early post-SAH ; Glu was decreased by inducing mild hypothermia (33-35 degree C). The elevated NOx level was not influenced by hypothermia. In a head-injured patient in whom microdialysis probe was inserted, perfusate NOx was increased 1-2 hours in advance to peaks of intracranial pressure changes.Discussion ; Sampling extracellular fluid with a microdialysis technique is superior to venous blood or CSF sampling for obtaining information regarding intracranial metabolic environment, although large molecules can not be dialyzed. Decreases in CSF Glu might represent the inhibitory effect of mild hypothermia upon excitotoxic process. NOx may be included in the development of traumatic brain injury, in which microdialysis method will be a promising real-time monitor for pathophysiologic process. Less

目的;除了常规的电生理监测外，临床上还引入了几种生化指标，从而检测神经代谢过程的紊乱，新开发的治疗方法将集中于此。方法：在缺氧性脑病，测量颈静脉球血液中的氧饱和度和乳酸浓度，以评估相对于动脉球的无氧代谢的存在。复苏后即刻低灌注期。本研究通过测定脑脊液（CSF）中谷氨酸（Glu ; HPLC）和一氧化氮（NO2，NO3 ;毛细管电泳）含量，探讨亚低温对蛛网膜下腔出血（SAH）合并脑血管痉挛（CVS）兴奋性毒性过程的影响。结果：脑损伤患者脑组织中乳酸浓度高于对照组，脑损伤患者脑组织中谷氨酸浓度高于对照组，脑损伤患者脑组织中乳酸浓度高于对照组 ...更多信息 非存活者的动脉血和静脉血比存活者的要多。然而，存活者和非存活者之间乳酸的动静脉差异无统计学差异。SAH后早期CSF Glu水平升高;通过诱导轻度低温（33-35 ℃）降低Glu。升高的NOx水平不受低温的影响。在一个头部受伤的病人，其中微透析探针插入，灌流液NOx增加提前1-2小时的颅内压变化的峰值Discussion ;采样细胞外液与微透析技术是上级静脉血或CSF采样获得有关颅内代谢环境的信息，虽然大分子不能被透析。脑脊液中Glu的降低可能代表亚低温对兴奋性毒性过程的抑制作用。脑外伤后NO可能参与了脑损伤的发生发展过程，微透析技术有望成为脑外伤病理生理过程的实时监测手段。少

项目成果

Ken Nakashima,et al.: "The relation between cerebral metabolic rate and ischemic depolarization. A comparison of the effects of hypothermia,pentobarbital and isoflurane." Anesthesiology :. 82. 1199-1208 (1995)

Ken Nakashima 等人：“脑代谢率与缺血性去极化之间的关系。低温、戊巴比妥和异氟烷效果的比较。”

Tsuyoshi Maekawa et al.: "Clinical application of mild hypothermia in neurological disorders." Minerva Anestesiologica. 60. 537-540 (1994)

Tsuyoshi Maekawa 等人：“亚低温在神经系统疾病中的临床应用。”

Tsuyoshi Maekawa,et al.: "Clinical application of mild hypothermia in neurlological disorders." Minerva Anestesiologica. 60. 537-540 (1994)

Tsuyoshi Maekawa 等人：“亚低温在神经系统疾病中的临床应用。”

Akio Tateishi,et al.: "Changes in perfusate nitric oxide levels in relation to change in intracranial pressure in severely head-injured patients." Stroke. (in preparation).

Akio Tateishi 等人：“严重头部受伤患者的灌注液一氧化氮水平的变化与颅内压的变化相关。”

Ken Nakashima, et al.: "The relation between cerebral metabolic rate and ischemic depolarization. A comparison of the effects of hypothermia, pentobarbital and isoflurane." Anesthesiology. 82(5). 1199-1208 (1995)

Ken Nakashima 等人：“脑代谢率与缺血性去极化之间的关系。低温、戊巴比妥和异氟烷效果的比较。”