Department of Neurosurgery, Hospital Clinic of Barcelona, 08036, Barcelona, Spain.
IDIBAPS Biomedical Research Institute, 08036, Barcelona, Spain.
Sci Rep. 2024 Mar 28;14(1):7388. doi: 10.1038/s41598-024-57217-5.
Intrahospital transfer (IHT), a routine in the management of neurocritical patients requiring imaging or interventions, might affect brain metabolism. Studies about IHT effects using microdialysis (MD) have produced conflicting results. In these studies, only the most damaged hemisphere was monitored, and those may not reflect the impact of IHT on overall brain metabolism, nor do they address differences between the hemispheres. Herein we aimed to quantify the effect of IHT on brain metabolism by monitoring both hemispheres with bilateral MD. In this study, 27 patients with severe brain injury (10 traumatic brain injury and 17 subarachnoid hemorrhage patients) were included, with a total of 67 IHT. Glucose, glycerol, pyruvate and lactate were measured by MD in both hemispheres for 10 h pre- and post-IHT. Alterations in metabolite levels after IHT were observed on both hemispheres; although these changes were more marked in hemisphere A (most damaged) than B (less damaged). Our results suggest that brain metabolism is altered after an IHT of neurocritical ill patients particularly but not limited to the damaged hemisphere. Bilateral monitorization may be more sensitive than unilateral monitorization for detecting metabolic disturbances not directly related to the course of the disease.
院内转院（IHT）是神经危重症患者管理中常见的操作，需要进行影像学检查或介入治疗。然而，IHT 可能会影响脑代谢。使用微透析（MD）研究 IHT 影响的研究结果相互矛盾。在这些研究中，仅监测了损伤最严重的半球，这可能无法反映 IHT 对整体脑代谢的影响，也无法说明两个半球之间的差异。在此，我们旨在通过双侧 MD 监测双侧来量化 IHT 对脑代谢的影响。在这项研究中，纳入了 27 例严重脑损伤患者（10 例创伤性脑损伤和 17 例蛛网膜下腔出血患者），共进行了 67 次 IHT。在 IHT 前后 10 小时内，通过 MD 测量了双侧半球的葡萄糖、甘油、丙酮酸和乳酸水平。在两个半球上均观察到 IHT 后代谢物水平的变化；尽管这些变化在 A 半球（损伤最严重）比 B 半球（损伤较轻）更明显。我们的研究结果表明，神经危重症患者的 IHT 后脑代谢会发生改变，特别是但不限于损伤半球。双侧监测可能比单侧监测更敏感，能检测到与疾病进程无关的代谢紊乱。
