Hogg Florence R A, Gallagher Mathew J, Kearney Siobhan, Zoumprouli Argyro, Papadopoulos Marios C, Saadoun Samira
Academic Neurosurgery Unit, St. George's Hospital, University of London, London, United Kingdom.
Neuro-intensive Care Unit, St. George's Hospital, University of London, London, United Kingdom.
J Neurotrauma. 2020 May 1;37(9):1156-1164. doi: 10.1089/neu.2019.6789. Epub 2020 Apr 1.
In some centers, monitoring lumbar cerebrospinal fluid (CSF) is used to guide management of patients with acute traumatic spinal cord injuries (TSCI) and draining lumbar CSF to improve spinal cord perfusion. Here, we investigate whether the lumbar CSF provides accurate information about the injury site and the effect of draining lumbar CSF on injury site perfusion. In 13 TSCI patients, we simultaneously monitored lumbar CSF pressure (CSFP) and intraspinal pressure (ISP) from the injury site. Using CSFP or ISP, we computed spinal cord perfusion pressure (SCPP), vascular pressure reactivity index (sPRx) and optimum SCPP (SCPP). We also assessed the effect on ISP of draining 10 mL CSF. Metabolites at the injury site were compared with metabolites in the lumbar CSF. We found that ISP was pulsatile, but CSFP had low pulse pressure and was non-pulsatile 21% of the time. There was weak or no correlation between CSFP versus ISP ( = -0.11), SCPP versus SCPP ( = 0.39), and sPRx versus ( = 0.45). CSF drainage caused no significant change in ISP in 7/12 patients and a significant drop of <5 mm Hg in 4/12 patients and of ∼8 mm Hg in 1/12 patients. Metabolite concentrations in the CSF versus the injury site did not correlate for lactate ( = 0.00), pyruvate ( = -0.12) or lactate-to-pyruvate ratio ( = -0.05) with weak correlations noted for glucose ( = 0.31), glutamate ( = 0.61), and glycerol ( = 0.56). We conclude that, after a severe TSCI, monitoring from the lumbar CSF provides only limited information about the injury site and that lumbar CSF drainage does not effectively reduce ISP in most patients.
在一些中心，监测腰椎脑脊液（CSF）被用于指导急性创伤性脊髓损伤（TSCI）患者的治疗，并通过引流腰椎脑脊液来改善脊髓灌注。在此，我们研究腰椎脑脊液是否能提供有关损伤部位的准确信息以及引流腰椎脑脊液对损伤部位灌注的影响。在13例TSCI患者中，我们同时监测了损伤部位的腰椎脑脊液压力（CSFP）和椎管内压力（ISP）。利用CSFP或ISP，我们计算了脊髓灌注压（SCPP）、血管压力反应指数（sPRx）和最佳SCPP（SCPP）。我们还评估了引流10 mL脑脊液对ISP的影响。将损伤部位的代谢物与腰椎脑脊液中的代谢物进行了比较。我们发现ISP呈搏动性，但CSFP脉压较低，且21%的时间无搏动性。CSFP与ISP（r = -0.11）、SCPP与SCPP（r = 0.39）以及sPRx与r（r = 0.45）之间存在弱相关性或无相关性。脑脊液引流在7/12例患者中未引起ISP的显著变化，在4/12例患者中引起<5 mmHg的显著下降，在1/12例患者中引起约8 mmHg的下降。脑脊液与损伤部位的乳酸（r = 0.00）、丙酮酸（r = -0.12）或乳酸与丙酮酸比值（r = -0.05）的代谢物浓度无相关性，而葡萄糖（r = 0.31）、谷氨酸（r = 0.61）和甘油（r = 0.56）存在弱相关性。我们得出结论，在严重TSCI后，从腰椎脑脊液进行监测只能提供关于损伤部位的有限信息，并且在大多数患者中，腰椎脑脊液引流并不能有效降低ISP。
