Clinical application of neurochemical monitoring

目的;在常规电生理监测的基础上，在临床上引入几种生化指标，从而检测神经代谢过程的紊乱，从而开发出新的治疗方法。主题;缺氧脑病，蛛网膜下腔出血，头部外伤（15例）。方法;在缺氧脑病中，测量颈静脉球血中的氧饱和度和乳酸浓度，以评估复苏后立即相对低灌注阶段无氧代谢的存在。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）水平，评价亚低温对蛛网膜下腔出血（SAH）合并脑血管痉挛患者兴奋毒性过程的影响。在严重颅脑损伤患者中，测量微透析灌注液中的Glu和NOx水平。结果;非幸存者的动脉血和静脉血乳酸浓度均高于幸存者。然而，在幸存者和非幸存者之间，乳酸的动静脉差异没有统计学差异。sah后早期脑脊液Glu水平升高；诱导亚低温（33-35℃）降低Glu。升高的氮氧化物水平不受低温的影响。在插入微透析探头的头部损伤患者中，灌注NOx在颅内压变化峰值前1-2小时增加。讨论;在获取颅内代谢环境信息方面，采用微透析技术对细胞外液进行取样优于静脉血或脑脊液取样，尽管大分子不能透析。脑脊液Glu的降低可能代表了亚低温对兴奋毒性过程的抑制作用。NOx可能参与了创伤性脑损伤的发展过程，微透析技术将成为一种有前景的实时监测病理生理过程的方法。少

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