Mendelowitsch A, Langemann H, Alessandri B, Kanner A, Landolt H, Gratzl O
Department of Research, Cantonal Hospital, Basel, Switzerland.
Acta Neurochir Suppl. 1996;67:48-52. doi: 10.1007/978-3-7091-6894-3_11.
Using microdialysis combined with suitable analytical methods, levels of metabolites in the extracellular fluid of the cerebral cortex were monitored during neurovascular surgery (9 aneurysm and 5 bypass operations). Our aim was to use microdialysis to detect any local ischaemia which could be caused by brain retraction, temporary clipping and dissecting manoevres. For this purpose, parameters were quantified whose levels in the dialysate are known to be influenced by ischaemia (on-line pH, ascorbic acid, uric acid, glutathione, cysteine, glucose, lactate). In the aneurysm series, the on-line pH fell after introduction of the retractor, and rose after removal: also, in many cases, levels of ascorbic acid, glutathione and lactate increased and glucose decreased. These changes are all in accordance with ischaemic conditions in the region of the probe; they disappeared at the end of retraction, or sometimes even before. During the bypass operations, there were no marked changes in on-line pH or in any of the measured parameters. However, in 2 of these patients ascorbic acid, uric acid and glucose levels were very high during the whole measurement, indicating possible changes in metabolism caused by inadequate perfusion (carotid artery stenosis). We conclude that microdialysis is a sensitive method of detecting intraoperative changes in cerebral metabolism.
采用微透析技术并结合合适的分析方法，在神经血管手术（9例动脉瘤手术和5例搭桥手术）过程中监测大脑皮质细胞外液中代谢物的水平。我们的目的是利用微透析检测因脑牵拉、临时夹闭和解剖操作可能导致的局部缺血。为此，对透析液中已知受缺血影响的参数进行了定量分析（在线pH值、抗坏血酸、尿酸、谷胱甘肽、半胱氨酸、葡萄糖、乳酸）。在动脉瘤手术系列中，牵开器置入后在线pH值下降，移除后上升；此外，在许多病例中，抗坏血酸、谷胱甘肽和乳酸水平升高，葡萄糖水平降低。这些变化均与探头所在区域的缺血情况相符；它们在牵拉结束时消失，有时甚至在此之前就已消失。在搭桥手术过程中，在线pH值或任何测量参数均无明显变化。然而，在其中2例患者中，整个测量过程中抗坏血酸、尿酸和葡萄糖水平都非常高，表明可能存在因灌注不足（颈动脉狭窄）导致的代谢变化。我们得出结论，微透析是检测术中脑代谢变化的一种灵敏方法。
