Nakamura Takehiro, Kuroda Yasuhiro, Torigoe Natsuyo, Abe Yuko, Yamashita Susumu, Kawakita Kenya, Kawai Nobuyuki, Tamiya Takashi, Itano Toshifumi, Nagao Seigo
Department of Neurobiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0173, Japan.
Acta Neurochir Suppl. 2008;102:203-6. doi: 10.1007/978-3-211-85578-2_40.
The aim of the present study was to evaluate cerebral metabolism monitoring during therapeutic hypothermia for global ischemic brain damage after cardiopulmonary resuscitation (CPR).
Jugular venous sampling and positron emission tomography (PET) were used. Seven comatose patients with cardiopulmonary arrest underwent hypothermia treatment as soon as possible after CPR. The body temperature of these patients was maintained at 34 degrees C for 72 h. Rewarming was performed at a rate of 1 degrees C/day. To monitor jugular venous saturation (SjO2) and lactate (lac-JV), a fiberoptic catheter was inserted into the jugular bulb. Oxygen extraction fraction (OEF) was calculated using the difference between arterial oxygen saturation (SaO2) and SjO2. 18F-fluorodeoxyglucose (FDG) PET was performed to investigate cerebral glucose metabolism at the end of therapeutic hypothermia.
The OEF was significantly increased at the end of hypothermia in four patients with favorable outcome on the Glasgow Outcome Scale (hypothermia onset 15.3 +/- 2.0% vs. hypothermia end 30.3 +/- 2.8%, P < 0.05). In three patients with unfavourable outcome (severe or worse on the Glasgow Outcome Scale), end hypothermia OEF tended to be low. There was also a reduction in FDG uptake in these three patients with unfavourable outcome. The lac-JV was significantly decreased at the end ofhypothermia treatment compared with hypothermia onset (27.7 +/- 7.4 vs. 6.0 +/- 3.0 mg/dL, P < 0.05).
The measurement of cerebral metabolism parameters, especially OEF, might be useful for estimation of hypothermia therapy in patients with unconsciousness after resuscitation after cardiac arrest.
本研究旨在评估心肺复苏（CPR）后治疗性低温期间对全脑缺血性脑损伤的脑代谢监测情况。
采用颈静脉采样和正电子发射断层扫描（PET）。7例心肺骤停的昏迷患者在CPR后尽快接受低温治疗。这些患者的体温维持在34℃达72小时。复温速率为1℃/天。为监测颈静脉血氧饱和度（SjO2）和乳酸（lac-JV），将一根光纤导管插入颈静脉球部。氧摄取分数（OEF）通过动脉血氧饱和度（SaO2）与SjO2的差值计算得出。在治疗性低温结束时进行18F-氟脱氧葡萄糖（FDG）PET检查以研究脑葡萄糖代谢情况。
格拉斯哥预后量表评定预后良好的4例患者在低温结束时OEF显著升高（低温开始时为15.3±2.0%，低温结束时为30.3±2.8%，P<0.05）。格拉斯哥预后量表评定预后不良（严重或更差）的3例患者，低温结束时OEF往往较低。这3例预后不良的患者FDG摄取也减少。与低温开始时相比，低温治疗结束时lac-JV显著降低（27.7±7.4对6.0±3.0mg/dL，P<0.05）。
脑代谢参数的测量，尤其是OEF，可能有助于评估心脏骤停复苏后昏迷患者的低温治疗效果。
