Division of Critical Care Neurology, Department of Neurology, Columbia University Medical Center, New York, NY 10032, USA.
Stroke. 2011 Jun;42(6):1534-9. doi: 10.1161/STROKEAHA.110.604488. Epub 2011 Apr 14.
Global cerebral edema is common among patients with poor-grade subarachnoid hemorrhage and is associated with poor outcome. Currently no targeted therapy exists largely due to an incomplete understanding of the underlying mechanisms.
This is a prospective observational study including 39 consecutive patients with poor-grade subarachnoid hemorrhage with multimodal neuromonitoring. Levels of microdialysate lactate-pyruvate ratio, episodes of cerebral metabolic crisis (lactate-pyruvate ratio >40 and brain glucose <0.7 mmol/L), brain tissue oxygen tension, cerebral perfusion pressure, and transcranial Doppler sonography flow velocities were analyzed.
Median age was 54 years (range, 45 to 61 years) and 62% were female. Patients with global cerebral edema on admission (n=24 [62%]) had a higher incidence of metabolic crisis in the first 12 hours of monitoring (n=15 [15% versus 2%], P<0.05) and during the total time of neuromonitoring (20% versus 3%, P<0.001) when compared to those without global cerebral edema. There was no difference in brain tissue oxygen tension or cerebral perfusion pressure between the groups; however, in patients with global cerebral edema, a higher cerebral perfusion pressure was associated with lower lactate-pyruvate ratio (P<0.05). Episodes of metabolic crisis were associated with poor outcome (modified Rankin Scale score 5 or 6, P<0.05).
In patients with poor-grade subarachnoid hemorrhage, global cerebral edema is associated with early brain metabolic distress.
全球脑肿胀是预后不良的患者蛛网膜下腔出血的常见并发症，与不良预后相关。目前，由于对潜在机制的不完全了解，还没有针对该疾病的靶向治疗方法。
这是一项纳入 39 例连续的伴有多模态神经监测的不良级别蛛网膜下腔出血患者的前瞻性观察研究。分析微透析液中乳酸-丙酮酸比值、脑代谢危机（乳酸-丙酮酸比值>40 和脑葡萄糖<0.7mmol/L）发作、脑组织氧张力、脑灌注压和经颅多普勒超声血流速度的水平。
中位年龄为 54 岁（范围为 45 至 61 岁），62%为女性。入院时伴有全脑肿胀的患者在监测的前 12 小时内（15%比 2%，P<0.05）和在整个神经监测期间（20%比 3%，P<0.001）发生代谢危机的发生率更高。与无全脑肿胀的患者相比，两组之间的脑组织氧张力或脑灌注压无差异；然而，在伴有全脑肿胀的患者中，较高的脑灌注压与较低的乳酸-丙酮酸比值相关（P<0.05）。代谢危机的发作与不良预后相关（改良 Rankin 量表评分为 5 或 6，P<0.05）。
在伴有不良级别蛛网膜下腔出血的患者中，全脑肿胀与早期脑代谢紊乱有关。
