Lee Hyoung Youn, Mamadjonov Najmiddin, Jung Yong Hun, Jeung Kyung Woon, Kim Tae-Hoon, Kim Jin Woong, Kim Hyung Joong, Gumucio Jorge Antonio, Salcido David D
Trauma Center, Chonnam National University Hospital, Gwangju, Republic of Korea.
Department of Medical Science, Chonnam National University Graduate School, Gwangju, Republic of Korea.
Neurocrit Care. 2025 Feb;42(1):261-276. doi: 10.1007/s12028-024-02084-1. Epub 2024 Aug 8.
Cerebral blood flow (CBF) decreases in the first few hours or days following resuscitation from cardiac arrest, increasing the risk of secondary cerebral injury. Using data from experimental studies performed in minipigs, we investigated the relationships of parameters derived from arterial and jugular bulb blood gas analyses and lactate levels (jugular bulb parameters), which have been used as indicators of cerebral perfusion and metabolism, with CBF and the cerebral lactate to creatine ratio measured with dynamic susceptibility contrast magnetic resonance imaging and proton magnetic resonance spectroscopy, respectively.
We retrospectively analyzed 36 sets of the following data obtained during the initial hours following resuscitation from cardiac arrest: percent of measured CBF relative to that at the prearrest baseline (%CBF), cerebral lactate to creatine ratio, and jugular bulb parameters, including jugular bulb oxygen saturation, jugular bulb lactate, arterial-jugular bulb oxygen content difference, cerebral extraction of oxygen, jugular bulb-arterial lactate content difference, lactate oxygen index, estimated respiratory quotient, and arterial-jugular bulb hydrogen ion content difference. Linear mixed-effects models were constructed to examine the effects of each jugular bulb parameter on the %CBF and cerebral lactate to creatine ratio.
The arterial-jugular bulb oxygen content difference (P = 0.047) and cerebral extraction of oxygen (P = 0.030) had a significant linear relationship with %CBF, but they explained only 12.0% (95% confidence interval [CI] 0.002-0.371) and 14.2% (95% CI 0.005-0.396) of the total %CBF variance, respectively. The arterial-jugular bulb hydrogen ion content difference had a significant linear relationship with cerebral lactate to creatine ratio (P = 0.037) but explained only 13.8% (95% CI 0.003-0.412) of the total variance in the cerebral lactate to creatine ratio. None of the other jugular bulb parameters were related to the %CBF or cerebral lactate to creatine ratio.
In conclusion, none of the jugular bulb parameters appeared to provide sufficient information on cerebral perfusion and metabolism in this setting.
心脏骤停复苏后的最初数小时或数天内，脑血流量（CBF）会下降，从而增加继发性脑损伤的风险。利用小型猪实验研究的数据，我们调查了动脉血和颈静脉球部血气分析及乳酸水平（颈静脉球部参数）所衍生参数与CBF以及分别通过动态磁敏感对比磁共振成像和质子磁共振波谱测量的脑乳酸与肌酸比值之间的关系，这些参数已被用作脑灌注和代谢的指标。
我们回顾性分析了心脏骤停复苏后最初数小时内获得的36组以下数据：测量的CBF相对于骤停前基线的百分比（%CBF）、脑乳酸与肌酸比值以及颈静脉球部参数，包括颈静脉球部氧饱和度、颈静脉球部乳酸、动脉 - 颈静脉球部氧含量差、脑氧摄取率、颈静脉球部 - 动脉乳酸含量差、乳酸氧指数、估计呼吸商以及动脉 - 颈静脉球部氢离子含量差。构建线性混合效应模型以检查每个颈静脉球部参数对%CBF和脑乳酸与肌酸比值的影响。
动脉 - 颈静脉球部氧含量差（P = 0.047）和脑氧摄取率（P = 0.030）与%CBF有显著线性关系，但它们分别仅解释了总%CBF方差的12.0%（95%置信区间[CI] 0.002 - 0.371）和14.2%（95%CI 0.005 - 0.396）。动脉 - 颈静脉球部氢离子含量差与脑乳酸与肌酸比值有显著线性关系（P = 0.037），但仅解释了脑乳酸与肌酸比值总方差的13.8%（95%CI 0.003 - 0.412）。其他颈静脉球部参数均与%CBF或脑乳酸与肌酸比值无关。
总之，在此情况下，似乎没有一个颈静脉球部参数能提供关于脑灌注和代谢的足够信息。
