重型颅脑创伤患者局部脑组织氧分压与能量代谢物的关系  

Correlations between Regional Brain Tissue Oxygen Partial Pressure and Extra Cellular Energy Metabolite Alteration on Patient with Severe Traumatic Brain Injury

作　　者：张国斌[1] 只达石[1] 张赛[1] 黄慧玲[1] 杨智[1] 李爱林[1] 莫丽冬[1] 

机构地区：[1]天津市环湖医院,300060

出　　处：《天津医药》2004年第9期529-531,共3页Tianjin Medical Journal

基　　金：家自然科学基金资助项目 (项目编号 :30371462);天津市重点攻关课题 (项目编号 :013111211)

摘　　要：目的 :研究脑组织细胞外液(extracellularfluid,ECF)中能量代谢物的变化与脑组织氧分压[p(O2)]之间的关系。方法 :14例格拉斯哥昏迷评分3～8分的重型颅脑创伤患者 ,使用LICOX或Neurotrend_7系统监测脑组织p(O2)的同时 ,用微透析技术监测ECF中葡萄糖 (Glu)、乳酸 (Lac)、丙酮酸 (Pyru)浓度并计算乳酸/葡萄糖比值(L/G)和乳酸/丙酮酸比值 (L/P)。监测创伤周边区的白质 ,微透析探针灌注速率为0 3μL/min ,标本和数据每1h同步采集、记录1次。结果 :脑组织 p(O2)和L/G逐渐升高 ,Glu下降 ;脑组织 p(O2)与Glu呈负相关(rs= -0.355,P<0.01) ,脑组织p(O2)与L/G呈正相关(rs=0.543,P<0.01)。结论Objective:To investigate the relationship between brain tissue p(O 2 )and extracellular energy metabolite alterations monitored by intracranial microdialysis.Methods:14cases with GCS3～8fen were studied.Intracranial microdialysis and brain tissue p(O 2 )monitoring were applied when the subjects were adˉmitted into the NICU directly or post operation.Microdialysis probes were inserted into the parainjuried zone2.5cm subcortically at the end of evacuation procedures or via the bolt kit fixed on skull burr hole,the sampling duration is29～92h.Perfusion rate was0.3μL/min.LICOX System and Neurotrend-7System were used on11cases and3cases,respectively.Insert the calibrated probe via a burr hole frontally in2～3cm deep.Sampling and data were collected simultaneously hourly.To minimize the interaction of the catheters,the catheters should be kept at1.5cm distance from each other.Biochemical analysis of glucose,lactate and pyruvate were performed by the CMA600Microdialysis Analyzer.The data were grouped according to the different duration postinjury.Results:The glucose level has decreased and the lactate/glucose ratio has inˉcreased,with an improvement of cerebral radix state.There was a significant relation between brain tissue p(O 2 )and Glu(r s =-0.355,P<0.01),brain tissue p(O 2 )and lactate/glucose ratio(r s =0.543,P<0.01,Spearman's rank correlation).Conclusions:The improved oxygenation with concomitant lack of energy supˉplier is a characteristic of the changes during the early period of patient with severe traumatic brain injury.

关 键 词：脑组织氧分压 重型颅脑创伤 患者 能量代谢 局部 监测 白质 结论 供能 负相关 

分 类 号：R651.15[医药卫生—外科学] R743[医药卫生—临床医学]