亚低温对脑创伤患者脑组织糖代谢及甘油的影响  

Effect of Mild Hypothermia on Metabolism of Glucose and Glycerol of Brain Extracellular Fluid in Patients with Severe Traumatic Brain Injury

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

机构地区：[1]天津市环湖医院神经外科,300060

出　　处：《天津医药》2005年第5期260-262,共3页Tianjin Medical Journal

基　　金：国家自然科学基金资助课题(项目编号:30371462)

摘　　要：目的:研究亚低温对重型脑创伤患者脑细胞间液能量代谢及甘油的影响。方法:将微透析探针分别置入16例重型脑创伤(sTBI)患者半暗区及病灶对侧的相应位置(正常区),分析受伤后、亚低温期及复温后脑细胞间液(ECF)的乳酸(L)、乳酸/丙酮酸(L/P)、乳酸/葡萄糖(L/G)及甘油浓度(Gly)。结果:半暗区亚低温12h后ECF的Gly、L、L/P及L/G比亚低温治疗前明显降低并维持到复温后,正常区亚低温12h后ECF的L、L/P及L/G比亚低温治疗前明显降低(P<0.05)。两区亚低温12h后与复温后比较,脑ECF的各项指标差别无统计学意义(P>0.05)。亚低温前、亚低温12h后半暗区脑ECF的L、L/P及Gly均比正常区明显增高。结论:亚低温治疗可能通过降低半暗区脑ECF中L/P、L/G及Gly的浓度及正常区L/P的浓度而发挥脑保护作用;颅脑创伤后半暗区更易发生能量代谢紊乱及细胞膜降解,亚低温对这一区域有显著保护作用。Objective: To study the effect of mild hypothermia on metabolism of glucose and glycerol of brain tissue with severe traumatic brain injury. Methods: All 16 cases with severe traumatic brain injury (GCS ≤ 8)were treated by mild therapeutic cerebral hypothermia therapy. Microdialysis catheters were inserted into the perilesion and the opposite mirror site. Brain dialysate after brain injury, during and after mild hypothermia duration was collected. Biochemical analysis of lactate, lactate/pyruvate,lactate/glucose and glycerol was performed by the CMA Microdialysis analyzer. Results: During and after mild hypothermia, the lactate, the lactate/glucose ratio ,the lactate/pyruvate ratio and the glycerol in perilension were significantly decreased compared with those before injury(P < 0.05). Normal brain tissue : twelve hours after mild hypothermia therapy, the lactate, the lactate/pyruvate and the lactate/glucose in the normal brain tissue were significantly decreased and the glycerol was steady. After brain injury, the lactate, the lactate/pyruvate ratio and the glycerol in perilension were higher than that in relative normal brain and the lactate/glucose was steady. Twelve hours after mild hypothermia therapy, the lactate, the lactate/pyruvate ratio and the glycerol in perilension were higher than that in relative normal brain and the lactate/glucose was steady. Conclusion: Mild hypothermia protects brain by decreasing the lactate/glucose, the lactate/pyruvate ratio and the glycerol in perilension and the lactate/pyruvate ratio in normal brain tissue. It is easier to occur the energy crisis and the breakdown of membrane phospholipid in perilension after traumatic brain injury. Mild hypothermia protects brain better in perilension than in the normal brain tissue.

关 键 词：创伤患者 甘油 糖代谢 脑组织 脑细胞间液 乳酸/丙酮酸 能量代谢紊乱 半暗区 微透析探针 ECF 亚低温治疗 脑保护作用 颅脑创伤后 复温后 亚低温期 治疗前 浓度 葡萄糖 统计学 膜降解 重型 

分 类 号：R378[医药卫生—病原生物学] R692.5[医药卫生—基础医学]