Department of Neurosurgery, Hospital of University of Pennsylvania, 3 Silverstein Building, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Neurocrit Care. 2011 Aug;15(1):134-8. doi: 10.1007/s12028-010-9467-6.
Propofol infusion syndrome (PRIS) is a rare but frequently fatal condition. It is characterized by cardiovascular collapse and metabolic derangement due to propofol exposure. The pathophysiology of PRIS is poorly understood, and its study has previously been limited to animal models and clinical observations. We present the first in vivo brain biochemical data in a patient with PRIS.
We report the case of a 37-year-old woman with PRIS following aneurysmal subarachnoid hemorrhage who was monitored by cerebral microdialysis (CMD). A CMD catheter was inserted into the brain and provided near real-time monitoring of brain energy-related metabolites, including lactate and pyruvate, during the time period surrounding the diagnosis of PRIS. We recorded propofol exposure, clinical manifestations, and relevant laboratory measurements.
CMD revealed a temporal association between propofol exposure and the cerebral lactate-to-pyruvate ratio (LPR). The LPR increased linearly after propofol was restarted following an off period, and the LPR decreased linearly after propofol was discontinued. Serum lactate correlated with clinical worsening after the onset of PRIS, whereas cerebral LPR correlated with propofol exposure.
Cerebral LPR may be a sensitive marker of PRIS. Increases in LPR following propofol exposure should alert clinicians to the possibility of PRIS and might prompt early discontinuation of propofol thereby avoiding fatal complications.
丙泊酚输注综合征（PRIS）是一种罕见但经常致命的病症。它的特征是由于丙泊酚暴露导致心血管崩溃和代谢紊乱。PRIS 的病理生理学尚未得到很好的理解，其研究以前仅限于动物模型和临床观察。我们报告了首例 PRIS 患者的体内脑部生化数据。
我们报告了一例 37 岁女性 PRIS 的病例，该患者患有蛛网膜下腔出血，在诊断为 PRIS 期间，通过脑微透析（CMD）进行监测。将 CMD 导管插入大脑，并在 PRIS 发生期间提供有关脑能量相关代谢物（包括乳酸和丙酮酸）的实时监测。我们记录了丙泊酚的暴露，临床表现和相关的实验室测量结果。
CMD 显示丙泊酚暴露与脑乳酸与丙酮酸比（LPR）之间存在时间相关性。在停用期后重新开始使用丙泊酚时，LPR 呈线性增加，停用丙泊酚时，LPR 呈线性下降。PRIS 发作后，血清乳酸与临床恶化相关，而脑 LPR 与丙泊酚暴露相关。
脑 LPR 可能是 PRIS 的敏感标志物。丙泊酚暴露后 LPR 的增加应引起临床医生对 PRIS 的可能性的警惕，并可能促使早期停止使用丙泊酚，从而避免致命的并发症。
