Persson L, Valtysson J, Enblad P, Warme P E, Cesarini K, Lewen A, Hillered L
Department of Neurosurgery, Uppsala University Hospital, Sweden.
J Neurosurg. 1996 Apr;84(4):606-16. doi: 10.3171/jns.1996.84.4.0606.
The authors have developed a method for routine monitoring of disturbances in brain energy metabolism and extracellular levels of excitatory amino acids using intracerebral microdialysis in 10 patients with subarachnoid hemorrhage. Microdialysis was conducted for periods ranging from 6 to 11 days after ictus. Altogether, 16,054 chemical analyses from 1647 dialysate samples were performed. Concentrations of the energy-related substances lactate, pyruvate, glucose, and hypoxanthine were measured, and the lactate/pyruvate ratio was calculated. The excitatory amino acids glutamate and aspartate were measured. The microdialysis data were matched with computerized tomography findings, clinical course, and outcome. The results support the concepts that microdialysis is a promising tool for chemical monitoring of the human brain and that extracellular fluid levels of lactate, lactate/pyruvate ratio, glucose, hypoxanthine, and glutamate are useful markers of disturbances in brain energy metabolism in neurointensive care patients. These results have generated a working hypothesis that the pattern of these extracellular markers may help differentiate between various causes of energy perturbations, such as hypoxia and different degrees of ischemia. The correlation between the dialysate levels of excitatory amino acids and outcome supports the concept of glutamate receptor overactivation in acute human brain injury.
作者们开发了一种方法，用于对10例蛛网膜下腔出血患者进行脑能量代谢紊乱和兴奋性氨基酸细胞外水平的常规监测，该方法采用脑内微透析技术。微透析在发病后6至11天内进行。总共对1647个透析液样本进行了16054次化学分析。测量了与能量相关的物质乳酸、丙酮酸、葡萄糖和次黄嘌呤的浓度，并计算了乳酸/丙酮酸比值。测量了兴奋性氨基酸谷氨酸和天冬氨酸。将微透析数据与计算机断层扫描结果、临床病程及预后进行了匹配。结果支持以下观点：微透析是用于人脑化学监测的一种有前景的工具，并且乳酸、乳酸/丙酮酸比值、葡萄糖、次黄嘌呤和谷氨酸的细胞外液水平是神经重症监护患者脑能量代谢紊乱的有用标志物。这些结果产生了一个工作假设，即这些细胞外标志物的模式可能有助于区分能量紊乱的各种原因，如缺氧和不同程度的缺血。兴奋性氨基酸透析液水平与预后之间的相关性支持急性人脑损伤中谷氨酸受体过度激活的概念。
