Landolt H, Langemann H, Mendelowitsch A, Gratzl O
Neurosurgical Clinic, Kantonspital, Aarau, Switzerland.
Acta Neurochir Suppl (Wien). 1994;60:475-8. doi: 10.1007/978-3-7091-9334-1_130.
We will report on our preliminary findings using microdialysis to monitor three patients in intensive care with either severe head injury (SHI) or severe subarachnoid hemorrhage (SAH) for up to 72 hours. In addition, basal levels in uninjured brain were assessed during an extra-intracranial bypass operation. Samples were collected hourly or half-hourly (flow rate 2 microliters/min, perfusion medium 0.9% saline). Parameters measured were the antioxidants ascorbic acid, uric acid, glutathione and cysteine. In 2 patients, the pH of the dialysate (pHD) was also measured on-line with a specially constructed flow-through meter, and glucose and lactate levels were assessed in the dialysate. In patient 1 (SHI), there was practically no cerebral perfusion pressure because of high ICP; cysteine and lactate levels were very high and glucose not measurable. In patient 2 (SAH) a hypoxic episode was accompanied by increased uric acid and decreased glucose. In patient 3 (SHI), the pHD reflected normalisation of blood gases after hyperventilation. Results indicate that parameters are in the range known from experimental studies, and can be correlated with clinical situations. The pHD as valuable indicator of metabolic changes is also feasible bedside.
我们将报告使用微透析技术对3例重症监护病房中患有严重颅脑损伤（SHI）或严重蛛网膜下腔出血（SAH）的患者进行长达72小时监测的初步结果。此外，在一次颅内旁路手术期间评估了未受伤脑组织的基础水平。每小时或半小时采集一次样本（流速2微升/分钟，灌注介质为0.9%生理盐水）。所测量的参数包括抗氧化剂维生素C、尿酸、谷胱甘肽和半胱氨酸。在2例患者中，还使用特制的流通式仪表在线测量透析液的pH值（pHD），并评估透析液中的葡萄糖和乳酸水平。在患者1（SHI）中，由于颅内压高，几乎没有脑灌注压；半胱氨酸和乳酸水平非常高，葡萄糖无法测量。在患者2（SAH）中，一次缺氧发作伴随着尿酸升高和葡萄糖降低。在患者3（SHI）中，pHD反映了过度通气后血气的正常化。结果表明，这些参数在实验研究已知的范围内，并且可以与临床情况相关联。pHD作为代谢变化的有价值指标在床边也是可行的。
