1Section of Neurosurgery, Department of Neuroscience.
2Anesthesiology and Intensive Care, Department of Surgical Sciences, and.
J Neurosurg. 2018 Jun;128(6):1762-1770. doi: 10.3171/2016.11.JNS161140. Epub 2017 Jun 2.
OBJECTIVE Delayed cerebral ischemia (DCI) following subarachnoid hemorrhage (SAH) is one of the major contributors to poor outcome. It is crucial to be able to detect early signs of DCI to prevent its occurrence. The objective of this study was to determine if low cerebral blood flow (CBF) measurements and pathological microdialysis parameters measured at the bedside can be observed early in patients with SAH who later developed DCI. METHODS The authors included 30 patients with severe SAH. The CBF measurements were performed at Day 0-3 after disease onset, using bedside xenon-CT. Interstitial glucose, lactate, pyruvate, glycerol, and glutamate were measured using microdialysis. RESULTS Nine of 30 patients developed DCI. Patients with DCI showed significantly lower global and regional CBF, and lactate was significantly increased in these patients. A high lactate/pyruvate ratio was also detected in patients with DCI. CONCLUSIONS Early low CBF measurements and a high lactate and lactate/pyruvate ratio may be early warning signs of the risk of developing DCI. The clinical value of these findings needs to be confirmed in larger studies.
蛛网膜下腔出血（SAH）后迟发性脑缺血（DCI）是预后不良的主要原因之一。能够早期发现 DCI 的迹象对于预防其发生至关重要。本研究旨在确定在后来发生 DCI 的 SAH 患者中，是否可以在床边观察到低脑血流（CBF）测量值和测量的病理性微透析参数。
作者纳入了 30 例严重的 SAH 患者。在发病后 0-3 天内，使用床边氙 CT 进行 CBF 测量。使用微透析测量细胞间葡萄糖、乳酸、丙酮酸、甘油和谷氨酸。
30 例患者中有 9 例发生 DCI。发生 DCI 的患者的全脑和局部 CBF 明显降低，乳酸明显增加。DCI 患者还检测到高乳酸/丙酮酸比值。
早期的低 CBF 测量值以及高乳酸和乳酸/丙酮酸比值可能是发生 DCI 风险的早期预警信号。这些发现的临床价值需要在更大的研究中得到证实。
