微透析监测严重创伤性脑损伤患者脑脊液参数：一种新方法。
Microdialysis Monitoring of CSF Parameters in Severe Traumatic Brain Injury Patients: A Novel Approach.
机构信息
Section for Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Solna , Stockholm , Sweden.
Section of Anesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet , Stockholm , Sweden.
出版信息
Front Neurol. 2014 Sep 2;5:159. doi: 10.3389/fneur.2014.00159. eCollection 2014.
BACKGROUND
Neuro-intensive care following traumatic brain injury (TBI) is focused on preventing secondary insults that may lead to irreversible brain damage. Microdialysis (MD) is used to detect deranged cerebral metabolism. The clinical usefulness of the MD is dependent on the regional localization of the MD catheter. The aim of this study was to analyze a new method of continuous cerebrospinal fluid (CSF) monitoring using the MD technique. The method was validated using conventional laboratory analysis of CSF samples. MD-CSF and regional MD-Brain samples were correlated to patient outcome.
MATERIALS AND METHODS
A total of 14 patients suffering from severe TBI were analyzed. They were monitored using (1) a MD catheter (CMA64-iView, n = 7448 MD samples) located in a CSF-pump connected to the ventricular drain and (2) an intraparenchymal MD catheter (CMA70, n = 8358 MD samples). CSF-lactate and CSF-glucose levels were monitored and were compared to MD-CSF samples. MD-CSF and MD-Brain parameters were correlated to favorable (Glasgow Outcome Score extended, GOSe 6-8) and unfavorable (GOSe 1-5) outcome.
RESULTS
Levels of glucose and lactate acquired with the CSF-MD technique could be correlated to conventional levels. The median MD recovery using the CMA64 catheter in CSF was 0.98 and 0.97 for glucose and lactate, respectively. Median MD-CSF (CMA 64) lactate (p = 0.0057) and pyruvate (p = 0.0011) levels were significantly lower in the favorable outcome group compared to the unfavorable group. No significant difference in outcome was found using the lactate:pyruvate ratio (LPR), or any of the regional MD-Brain monitoring in our analyzed cohort.
CONCLUSION
This new technique of global MD-CSF monitoring correlates with conventional CSF levels of glucose and lactate, and the MD recovery is higher than previously described. Increase in lactate and pyruvate, without any effect on the LPR, correlates to unfavorable outcome, perhaps related to the presence of erythrocytes in the CSF.
背景
创伤性脑损伤（TBI）后的神经重症监护专注于预防可能导致不可逆脑损伤的二次损伤。微透析（MD）用于检测紊乱的脑代谢。MD 的临床应用取决于 MD 导管的区域定位。本研究旨在分析一种使用 MD 技术进行连续脑脊液（CSF）监测的新方法。该方法通过对 CSF 样本的常规实验室分析进行验证。MD-CSF 和局部 MD-脑样本与患者预后相关。
材料和方法
共分析了 14 名患有严重 TBI 的患者。他们使用（1）位于与脑室引流管相连的 CSF 泵中的 MD 导管（CMA64-iView，n=7448 MD 样本）和（2）脑实质内 MD 导管（CMA70，n=8358 MD 样本）进行监测。监测 CSF 中的乳酸和葡萄糖水平，并与 MD-CSF 样本进行比较。将 MD-CSF 和 MD-脑参数与良好（扩展格拉斯哥预后评分，GOSe 6-8）和不良（GOSe 1-5）预后相关联。
结果
使用 CSF-MD 技术获得的葡萄糖和乳酸水平可与常规水平相关联。使用 CMA64 导管在 CSF 中的 MD 回收率中位数分别为葡萄糖和乳酸的 0.98 和 0.97。与不良预后组相比，良好预后组的 MD-CSF（CMA64）乳酸（p=0.0057）和丙酮酸（p=0.0011）水平显著降低。在我们分析的队列中，使用乳酸：丙酮酸比值（LPR）或任何局部 MD-脑监测均未发现预后差异。
结论
这种新的全局 MD-CSF 监测技术与葡萄糖和乳酸的常规 CSF 水平相关，MD 回收率高于以前的描述。乳酸和丙酮酸的增加，而 LPR 没有任何变化，与不良预后相关，这可能与 CSF 中红细胞的存在有关。
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