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首页> 外文期刊>Acta neurochirurgica.Supplement >Detection of secondary insults by brain tissue pO2 and bedside microdialysis in severe head injury.
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Detection of secondary insults by brain tissue pO2 and bedside microdialysis in severe head injury.

机译：通过脑组织pO2和床旁微透析检测重度颅脑损伤中的继发性损伤。

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摘要

We evaluated bedside cerebral on-line microdialysis for early detection of cerebral hypoxia in patients with traumatic brain injury. 24 severely head injured patients (Glasgow Coma Score < or = 8) were studied. Patients underwent continuous brain tissue PO2 (PtiO2) monitoring using the LICOX (GMS mbH, Germany) microcatheter device. The catheter was placed into the non-lesioned frontal white matter within 32.2 (7-48) hrs post injury. The microdialysis catheter (CMA 100, Sweden) was placed close to the PtiO2 probe via a 2- or 3-way skull screw, connected to a pump and perfused with Ringer solution (0.3 microliter/min). The microdialysis samples were collected hourly and analyzed at the bedside for glucose, lactate, lactate-pyruvate-ratio and glutamate (CMA 600, Sweden). We identified 252 episodes of impending hypoxia (PtiO2 < 15 mm Hg; 11,810 minutes) and 38 episodes of cerebral hypoxia (PtiO2 < 10 mm Hg; 1996 minutes). Before cerebral hypoxia, glucose decreased significantly. Glutamate was unchanged when no hypoxia or impending hypoxia occurred but increased 3-4 fold before a hypoxic episode appeared. We conclude that early metabolic detection of cerebral hypoxia before a critical decrease in brain tissue PtiO2 is seen and possibly allows earlier changes in treatment (e.g. reduction of hyperventilation therapy).
机译：我们评估了床旁脑部在线微透析对创伤性脑损伤患者脑缺氧的早期检测。研究了24名重度头部受伤的患者（格拉斯哥昏迷评分<或= 8）。使用LICOX（德国GMS mbH）微导管设备对患者进行连续的脑组织PO2（PtiO2）监测。在受伤后32.2（7-48）小时内，将导管放入未损伤的额叶白质中。将微透析导管（CMA 100，瑞典）通过两向或三向圆头螺钉放置在靠近PtiO2探针的位置，连接到泵上，并用林格溶液（0.3微升/分钟）灌注。每小时收集一次微透析样品，并在床边分析葡萄糖，乳酸，乳酸-丙酮酸比和谷氨酸（CMA 600，瑞典）。我们确定了252次即将发生的缺氧（PtiO2 <15毫米汞柱; 11,810分钟）和38次脑缺氧（PtiO2 <10毫米汞柱; 1996分钟）。在脑缺氧之前，葡萄糖显着下降。当没有发生缺氧或即将发生的缺氧时，谷氨酸没有变化，但在缺氧发作之前增加了3-4倍。我们得出的结论是，在脑组织PtiO2显着下降之前可以早期对脑缺氧进行代谢检测，并且可能允许更早进行治疗改变（例如减少过度换气疗法）。

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