Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
J Neurosurg. 2011 Jul;115(1):66-74. doi: 10.3171/2011.3.JNS10899. Epub 2011 Apr 8.
The aim in the present investigation was to study the relation between brain interstitial and systemic blood glucose concentrations during the acute phase after subarachnoid hemorrhage (SAH). The authors also evaluated the effects of insulin administration on local brain energy metabolism.
Nineteen patients with spontaneous SAH were prospectively monitored with intracerebral microdialysis (MD). The relation between plasma glucose and MD-measured interstitial brain glucose concentrations as well as the temporal pattern of MD glucose, lactate, pyruvate, glutamate, and glycerol was studied for 7 days after SAH. Using a target plasma glucose concentration of 5-10 mmol/L, the effect of insulin injection was also evaluated.
The mean (± SD) correlation coefficient between plasma glucose and MD glucose was 0.27 ± 0.27 (p = 0.0005), with a high degree of individual variation. Microdialysis glucose, the MD/plasma glucose ratio, and MD glutamate concentrations decreased in parallel with a gradual increase in MD pyruvate and MD lactate concentrations. There were no significant changes in the MD L/P ratio or MD glycerol levels. Insulin administration induced a decrease in MD glucose and MD pyruvate.
After SAH, there was a positive correlation between plasma and MD glucose concentrations with a high degree of individual variation. A gradual decline in MD glucose and the MD/plasma glucose ratio and an increase in MD pyruvate and MD lactate concentrations during the 1st week after SAH suggest a transition to a hyperglycolytic state with increased cerebral glucose consumption. The administration of insulin was related to a lowering of MD glucose and MD pyruvate, often to low levels even though plasma glucose values remained above 6 mmol/L. After SAH, the administration of insulin could impede the glucose supply of the brain.
本研究旨在探讨蛛网膜下腔出血（SAH）后急性期脑间质和全身血糖浓度之间的关系。作者还评估了胰岛素给药对局部脑能量代谢的影响。
19 例自发性 SAH 患者前瞻性接受颅内微透析（MD）监测。研究了 SAH 后 7 天内血浆葡萄糖与 MD 测量的脑间质葡萄糖浓度之间的关系以及 MD 葡萄糖、乳酸、丙酮酸、谷氨酸和甘油的时间模式。使用 5-10mmol/L 的目标血浆葡萄糖浓度，评估了胰岛素注射的效果。
血浆葡萄糖与 MD 葡萄糖之间的平均（±SD）相关系数为 0.27±0.27（p=0.0005），个体差异较大。MD 葡萄糖、MD/血浆葡萄糖比值和 MD 谷氨酸浓度逐渐降低，而 MD 丙酮酸和 MD 乳酸浓度逐渐升高。MD L/P 比值或 MD 甘油水平无明显变化。胰岛素给药可降低 MD 葡萄糖和 MD 丙酮酸。
SAH 后，血浆和 MD 葡萄糖浓度之间存在正相关，个体差异较大。SAH 后第 1 周，MD 葡萄糖和 MD/血浆葡萄糖比值逐渐降低，MD 丙酮酸和 MD 乳酸浓度升高，提示脑葡萄糖消耗增加，糖酵解状态逐渐转变。胰岛素给药与 MD 葡萄糖和 MD 丙酮酸降低有关，尽管血浆葡萄糖值仍高于 6mmol/L，但 MD 葡萄糖和 MD 丙酮酸常降至低值。SAH 后，胰岛素给药可能会阻碍大脑的葡萄糖供应。
