Bucci M N, Dechert R E, Arnoldi D K, Campbell J, McGillicuddy J E, Bartlett R H
Department of Surgery, University of Michigan, Ann Arbor.
Acta Neurochir (Wien). 1988;93(3-4):133-6. doi: 10.1007/BF01402895.
Both metabolic rate and protein catabolism are known to increase following severe head trauma, but the etiology of this hypermetabolism is unknown. To further investigate the problem, we studied the metabolism of 17 patients with indirect calorimetry who had severe craniocerebral trauma only and who required ICP monitoring for management. Patients were studied daily and immediately after ICP spikes greater than 20 mm Hg, prior to treatment with hyperventilation, osmotic diuretics, or barbiturates. Oxygen consumption (VO2) was correlated with ICP. Two groups of patients were identified. Group I patients were treated with hyperventilation and osmotic diuretics while Group II patients additionally received cerebral metabolic depressants. Group I had a significant correlation coefficient between VO2 and ICP. Significant hypercatabolism early in the post trauma period was demonstrated by increased urine urea nitrogen. Our observations suggest that in patients with craniocerebral trauma, elevated ICP is associated with increased oxygen consumption, protein catabolism and systemic hypermetabolism. Cerebral metabolic depressants blunted increases in VO2 which were seen with elevated ICP.
已知严重颅脑创伤后代谢率和蛋白质分解代谢均会增加，但这种高代谢的病因尚不清楚。为了进一步研究这个问题，我们对17例仅患有严重颅脑创伤且需要进行颅内压（ICP）监测以进行治疗的患者进行了间接测热法代谢研究。每天对患者进行研究，并在ICP峰值大于20 mmHg后立即进行研究，在使用过度通气、渗透性利尿剂或巴比妥类药物治疗之前。氧耗量（VO2）与ICP相关。确定了两组患者。第一组患者接受过度通气和渗透性利尿剂治疗，而第二组患者额外接受脑代谢抑制剂治疗。第一组VO2与ICP之间存在显著的相关系数。创伤后早期尿尿素氮增加表明存在显著的高分解代谢。我们的观察结果表明，在颅脑创伤患者中，ICP升高与氧耗量增加、蛋白质分解代谢和全身高代谢有关。脑代谢抑制剂可减弱ICP升高时VO2的增加。
