急性高血压脑出血患者脑糖氧代谢变化及意义  

The significance of changes in cerebral oxygen and glucose metabolism in patients with cerebral hemorrhage caused by acute hypertension

作　　者：马骏[1] 陈锷峰[2] 屠传建[2] 钱辉[2] 骆明[2] 顾志伟[2] 张建民[1] 

机构地区：[1]浙江大学医学院附属第二医院神经外科,杭州310009 [2]中国医科大学绍兴医院神经外科

出　　处：《中华急诊医学杂志》2014年第3期314-319,共6页Chinese Journal of Emergency Medicine

摘　　要：目的研究格拉斯哥昏迷评分（GCS）5～8分的高血压脑出血患者急性期脑糖氧代谢的变化情况，及其与预后的关系和干预治疗的意义。方法回顾性分析2011年1月1日至2012年6月30日浙江大学附属第二医院神经外科收治的格拉斯哥昏迷评分（GCS评分）5～8分的高血压脑出血患者共43例，其中男27例，女16例，男女比为1．7：1；年龄49～81（66．2±15．3）岁；基底节区脑出血28例，小脑出血6例，脑叶出血4例，桥脑出血5例；幕上血肿量≥30mL的25例，幕下血肿量≥10mL的10例；开颅血肿清除、去骨瓣减压术11例，其余均为保守治疗。病例纳入标准：全部病例均符合1995年全国第四届脑血管病学术会议修订的高血压性脑出血诊断标准，并经头部CT证实，发病24h内就诊，入院时格拉斯哥评分（GCS）5-8分；既往有高血压病史。病例排除标准：外伤性颅内血肿；自发性蛛网膜下腔出血；动、静脉畸形、Moyamoya病所致脑出血；肿瘤卒中；出凝血机制障碍引起的颅内出血；脑梗死性脑出血。颈内静脉逆行置管同时穿刺桡动脉留置导管监测血气和血糖，每6～8h或颅脑体征发生较大变化时分别采血送检；并特别采集急性发病后24h血样。一般监测3d。采集颈静脉血与桡动脉血，进行血气分析及血葡萄糖检查，计算颈内静脉氧饱和度（SjvO2）、脑氧利用率（CEO2）、脑动、静脉氧差（AVDO2）和血糖差（V-AGlu）、乳酸差（V-ALac）、颈内静脉与动脉血二氧化碳分压差（V-APCO2）的绝对值，根据短期预后将上述病例分为死亡组和存活组，并观察上述两组指标差异，及其与预后之间的关系。并从2012年7月到2013年1月进行了23个GCS评分5-8分的高血压脑出血患者的前瞻性双盲研究，根据发病3d内上述指标值进行了患者短期预后的判断。对资料采用SPSS16．0软件进行统计学处理，观察资料均为计�Objective To study the clinical significance of early changes in cerebral oxygen and glucose metabolism in patients with cerebral hemorrhage and with Glasgow coma score （GCS） of 5 -8 caused by acute hypertension in order to find relationship between those changes and prognosis. Methods From January 1,2011 to June 30, 2012, a cohort of 43 patients with cerebral hemorrhage caused by acute hypertension were enrolled for retrospective study. Radial artery and internal jugular vein were separately cannulated retrogradely for collecting blood for blood gas analysis and blood glucose tests carried out 24 hours after the onset of the cerebral hemorrhage and then every 6 - 8 hours and as any major changes in physical signs of patients occurred. And this monitoring kept for consecutive 3 days. The data of these laboratory findings were analyzed and calculated to determine internal jugular vein oxygen saturation （ SjVO2 ）, cerebral oxygen utilization rate （CEO2）, cerebral arterio-venous oxygen difference （AVDO2 ）, arterio-venous blood glucose difference （V-Aglu）, arterio-venous lactic acid difference （V-Alac） and absolute value of carbon dioxide pressure difference between jugular vein and artery （V-APCO2）. All patients met the diagnostic criteria of hypertensive cerebral hemorrhage revised by the 4th National Academic Conference on cerebrovascular disease in 1995 requiring diagnosis confirmed by brain CT, admitted within 24 hours of onset, Glasgow coma score （GCS） 5 - 8 and a history of hypertension. Exclusion criteria were ： cerebral hemorrhage caused by traumatic intracranial hematoma, spontaneous subarachnoid hemorrhage, arteriovenous malformation and Moyamoya disease, intracranial tumor apoplexy, cerebral bleeding derived from the disturbance of blood coagulation system, and cerebral hemorrhagic infarction. According to the short-term prognosis, the patients were divided into the death group and the survival group. Then the differences in biomarkers mentioned above between two groups w

关 键 词：高血压脑出血 糖代谢 脑氧代谢 格拉斯哥昏迷评分(GCS) 脑中风 继发性脑损害 预后 生存分析 

分 类 号：R544.1[医药卫生—心血管疾病] R743.34[医药卫生—内科学]