Continuous monitoring of focal brain and cerebrospinal fluid oxygen metabo-lism, acid-base balance, excitatory amino-acid, temperature, and blood flow in patients with severe head injury : Effects of intracranial hypertension, global ischemia, and hypothe

连续监测脑酸碱平衡和氧代谢已被引入神经重症监护环境。本研究采用多模式神经监测模式，假设过度通气和低温通过预防重型颅脑损伤患者脑缺血加重而改善脑酸中毒，患者和方法：连续监测脑脊液（CSF）pH、PCO_2、HCO_2<3->、碱过剩（BE）、P0_2、S0_2和温度，对13例重型颅脑损伤患者进行了乳酸和丙酮酸（La和Py）测定。将脑脊液温度校正参数与颈静脉血血氧饱和度（SjO_2）、局部血氧饱和度（rSO_2）、颅内压（ICP）、脑灌注压（CPP）、颈静脉血温度（Tjb）和呼气末二氧化碳分压（PetCO_2）进行相关分析。评价过度通气和低温治疗的意义。脑脊液酸中毒为0 ...更多信息 所有病例均表现为CSFPCO_2升高和/或CSFHCO_2降低<3->，并与ICP和/或CPP异常或监测时CSFP0_2和S0_2、rSO_2和/或SjO_2所示的缺血发作有关。2.脑脊液中PCO_2、La、Py升高和/或HCOy降低导致BE和pH值降低的作用较颈静脉血明显. CSF P0_2和S0_2降低仅与重度CSF酸中毒相关。4.过度通气：PetCO_2降低与CSFPCO_2降低和CSFpH升高并不总是密切相关。5.体温过低：Tjb与CSF pH和S 02呈负相关。结论：由CSFPCO 2、La和Py升高和/或HCO 2降低引起的CSF酸中毒<3->，往往与ICP和CPP异常，以及CSFS 02、rSO 2和/或SjO 2下降有关。低温而非过度通气有利于改善脑酸中毒和缺血。同时监测脑血流量、氧代谢、酸碱平衡和脑实质中的兴奋性氨基酸将进一步阐明重型颅脑损伤病例中神经保护治疗的有效性。少

Continuous monitoring of cerebral acid-base balance and oxygen metabolism has been introduced in neurointensive care settings. The hypothesis of this study utilizing multimodal neuromonitoring modali-ties is that hyperventilation and hypothermia improve cerebral acidosis through prevention of cerebralischemia aggravation in patients with severe head injury.Patients and Methods : Continuous monitoring of cerebrospinal fluid (CSF) pH, PCO_2, HCO_<3->, base excess (BE), P0_2, S0_2, and temperature, and lactate and pyruvate (La and Py) measurements were conducted in 13 patients with severe head injury. Temperature-corrected CSF parameters were correlated with those in the jugular blood including oxygen saturation (SjO_2), regional oxygen saturation (rSO_2), intracranial pressure (ICP) and cerebral perfusion pressure (CPP), jugular blood temperature (Tjb), and endtidal PCO_2 (PetCO_2). Therapeutic significance of hyperventilation and hypothermia was evaluated.Results : 1. CSF acidosis was o … More bserved in all cases due to increased CSF PCO_2 and/or decreased CSF HCO_<3->, and tended to associate with abnormal ICP and/or CPP or ischemic episodes indicated by CSF P0_2 and S0_2, rSO_2, and/or SjO_2 during monitoring. 2. It was more obvious in CSF than in jugular blood that increased PCO_2, La and Py, and/or decreased HCOy resulted in decreased BE and pH.3. Decreased CSF P0_2 and S0_2 only associated with severe CSF acidosis. 4. Hyperventilation : Decreased PetCO_2 did not always closely correlate with CSF PCO_2 decrease and CSFpH increase. 5. Hypothermia : There were negative correlations of Tjb with CSF pH and S0_2 in all cases.Conclusions : CSF acidosis caused by increased CSF PCO_2, La and Py and/or decreased HCO_<3-> tended to associate with abnormal ICP and CPP, and desaturation indicated by CSF S0_2, rSO_2, and/or SjO_2.Hypothermia rather than hyperventilation tends to improve cerebral acidosis and ischemia.Future direction : Simultaneous monitoring of cerebral blood flow, oxygen metabolism, acid-base bal-ance, and excitatory amino acids in the brain parenchyma would be further clarification of the efficacy of neuroprotective treatments in cases of severe head injuries. Less