Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Department of Anesthesia and Intensive Care, Hospital Clinic Universitari, Valencia, Spain.
J Neurosurg Anesthesiol. 2020 Apr;32(2):162-169. doi: 10.1097/ANA.0000000000000582.
Studies in which brain metabolism has been monitored using microdialysis have indicated decreases in cerebral glucose concentration and increases in lactate concentration in patients with traumatic brain injury (TBI). However, few data are available on glucose and lactate concentrations in the cerebrospinal fluid (CSF) of TBI patients. This study investigates the relationship between CSF glucose and lactate concentrations and outcomes after TBI.
Consecutive adult (>18 y) TBI patients were admitted to our 35-bed medicosurgical between 2011 and 2014 and were included in the study if they met the following inclusion criteria: presence of an external ventricular drain (EVD) for intracranial pressure monitoring, daily analysis of CSF glucose and lactate concentrations for 4 consecutive days, and concomitant measurements of blood glucose/lactate concentrations. Neurological outcome was assessed at 3 months using the extended Glasgow Outcome Scale (GOS), and unfavorable outcome defined as a GOS 1 to 4.
Of 151 TBI patients who had an EVD, 56 met the inclusion criteria. Most EVDs were placed on the day of intensive care unit admission, and maintained for 10 (interquartile range: 6 to 14) days. On day 1, there was a weak but significant correlation between blood and CSF glucose concentrations (R=0.07, P=0.04), and a greater correlation between blood and CSF lactate (R=0.32, P<0.001). In multivariable analysis, day 1 CSF glucose/lactate ratio was independently associated with mortality (odds ratio: 0.22, 95% confidence interval: 0.08-0.61; P=0.003), and day 1 CSF lactate concentration with unfavorable outcome (odds ratio: 4.86; 95% confidence interval: 1.86-12.67; P=0.001).
Low CSF glucose/lactate ratio is observed in nonsurvivors after severe TBI and may have prognostic value.
使用微透析监测脑代谢的研究表明，创伤性脑损伤（TBI）患者的脑葡萄糖浓度降低，乳酸浓度升高。然而，关于 TBI 患者脑脊液（CSF）中葡萄糖和乳酸浓度的数据很少。本研究探讨了 TBI 后 CSF 葡萄糖和乳酸浓度与结局的关系。
连续纳入 2011 年至 2014 年入住我们 35 张病床的内科-外科混合病房的成年（>18 岁）TBI 患者，如果符合以下纳入标准，则将其纳入研究：存在用于颅内压监测的外部脑室引流（EVD）、连续 4 天每天分析 CSF 葡萄糖和乳酸浓度，以及同时测量血糖/乳酸浓度。神经功能预后在 3 个月时使用扩展格拉斯哥预后量表（GOS）进行评估，预后不良定义为 GOS 1 至 4。
在 151 例有 EVD 的 TBI 患者中，有 56 例符合纳入标准。大多数 EVD 放置在重症监护病房入院当天，持续 10（四分位间距：6 至 14）天。第 1 天，血液和 CSF 葡萄糖浓度之间存在微弱但有统计学意义的相关性（R=0.07，P=0.04），血液和 CSF 乳酸之间的相关性更强（R=0.32，P<0.001）。在多变量分析中，第 1 天 CSF 葡萄糖/乳酸比值与死亡率独立相关（比值比：0.22，95%置信区间：0.08-0.61；P=0.003），第 1 天 CSF 乳酸浓度与预后不良独立相关（比值比：4.86；95%置信区间：1.86-12.67；P=0.001）。
严重 TBI 后非幸存者 CSF 葡萄糖/乳酸比值较低，可能具有预后价值。
