Küchler Jan, Wojak Jann, Abusamha Abdulkareem, Ditz Claudia, Tronnier Volker Martin, Gliemroth Jan
Department of Neurosurgery, University of Lübeck, Germany.
Department of Neurosurgery, University of Lübeck, Germany.
Clin Neurol Neurosurg. 2017 Aug;159:1-5. doi: 10.1016/j.clineuro.2017.05.010. Epub 2017 May 10.
The purpose of this study was to analyze changes in brain tissue chemistry around percutaneous dilational tracheostomy (PDT) in patients with acute brain injury (ABI) in a retrospective single-center analysis.
We included 19 patients who had continuous monitoring of brain tissue chemistry and intracranial pressure (ICP) during a 20h period before and after PDT. Different microdialysis parameters (lactate, pyruvate, lactate pyruvate ratio (LPR), glycerol and glutamate) and values of ICP, cerebral perfusion pressure (CPP) and brain tissue oxygenation (PBrO) were recorded per hour. Mean values were compared between a 10h period before PDT (prePDT) and after PDT (postPDT).
Mean values of cerebral lactate, pyruvate, LPR, glycerol and glutamate did not differ significantly between prePDT and postPDT. In addition, the rate of patients, which exceeded the known threshold was similar between prePDT and postPDT. Only one patient showed a strong increase of cerebral glycerol during the postPDT period, but analysis of subcutaneous glycerol could exclude an intracerebral event. ICP, CPP and PBrO did not exhibit significant changes.
We could exclude the occurrence of cerebral metabolic crisis and the excess release of cerebral glutamate and glycerol in a series of 19 patients. Our results support the safety of PDT in patients with ABI.
本研究旨在通过回顾性单中心分析，剖析急性脑损伤（ABI）患者经皮扩张气管切开术（PDT）前后脑组织化学变化。
我们纳入了19例在PDT前后20小时内持续监测脑组织化学和颅内压（ICP）的患者。每小时记录不同的微透析参数（乳酸、丙酮酸、乳酸丙酮酸比值（LPR）、甘油和谷氨酸）以及ICP、脑灌注压（CPP）和脑组织氧合（PBrO）值。比较PDT前10小时（PDT前）和PDT后10小时（PDT后）的平均值。
PDT前和PDT后脑组织乳酸、丙酮酸、LPR、甘油和谷氨酸的平均值无显著差异。此外，超过已知阈值的患者比例在PDT前和PDT后相似。仅1例患者在PDT后期间脑组织甘油显著增加，但皮下甘油分析可排除脑内事件。ICP、CPP和PBrO未显示出显著变化。
在这19例患者中，我们可以排除脑代谢危机的发生以及脑组织谷氨酸和甘油的过度释放。我们的结果支持PDT对ABI患者的安全性。
