Yoshida K, Corwin F, Marmarou A
Division of Neurosurgery and Radiation Physics, Medical College of Virginia, Richmond.
Acta Neurochir Suppl (Wien). 1990;51:317-9. doi: 10.1007/978-3-7091-9115-6_107.
The metabolic brain acidosis after trauma has been thought to increase brain oedema and contribute to neurologic deterioration. Amelioration of the brain acidosis either by systemic buffering agents or by hyperventilation has been proposed as a method of treatment. The objective of this study was to explore brain oedema and the metabolic changes in brain that occur with the use of hyperventilation. Tromethamine and combination (THAM and hyperventilation) therapy in experimental fluid-percussion brain injury. Brain lactate, brain pH, inorganic phosphate (Pi) and ATP were measured by 1H and 31P magnetic resonance spectroscopy. Also Water content in brain tissue using the specific gravimetric technique were determined in 32 cats. Prolonged hyperventilation provided relative ischaemia in brain tissue and promoted more production of brain lactate, no recovery of PCr/Pi ratio, and no decrease in brain oedema. On the other hand the administration of THAM served to decrease production of brain lactate and brain oedema and promoted the recovery of cerebral energy dysfunction. THAM ameliorates the deleterious effects of hyperventilation by minimizing energy disturbance and also decreases brain oedema. We conclude that THAM may be effective in reducing brain tissue acidosis and helpful as a metabolic stabilizing agent following severe head injury.
创伤后的代谢性脑酸中毒被认为会加重脑水肿并导致神经功能恶化。有人提出通过全身缓冲剂或过度通气来改善脑酸中毒，以此作为一种治疗方法。本研究的目的是探讨过度通气时脑内发生的脑水肿及代谢变化。在实验性流体冲击脑损伤中使用三羟甲基氨基甲烷（THAM）及联合（THAM与过度通气）疗法。通过1H和31P磁共振波谱法测量脑乳酸、脑pH值、无机磷酸盐（Pi）和三磷酸腺苷（ATP）。同时，采用比重法测定了32只猫脑组织中的含水量。长时间过度通气会导致脑组织相对缺血，并促使脑乳酸生成增多，磷酸肌酸/无机磷酸盐（PCr/Pi）比值无法恢复，脑水肿也未减轻。另一方面，给予THAM可减少脑乳酸生成和脑水肿，并促进脑能量功能障碍的恢复。THAM通过最大限度减少能量紊乱来减轻过度通气的有害影响，还能减轻脑水肿。我们得出结论，THAM可能对减轻脑组织酸中毒有效，并且作为重度颅脑损伤后的代谢稳定药物可能会有帮助。
