欢迎访问《现代生物医学进展》编辑部！

目的：应用微透析技术对于中重型脑外伤患者进行持续脑内谷氨酸、乳酸以及葡萄糖，分析结果以评价以上因素与患者病情的关系。方法：选择我院2006 年3 月-2009 年11 月颅脑外科和ICU 收治的急性颅脑损伤患者32 例,根据GCS 分为重度昏迷组和中度昏迷组,均行急诊手术治疗,并在手术直视下置入微透析探针,置入后第4 天拔除,定时收集透析液约10μl,于术前以及术后第1、2、3、4 天收取标本并立即送检，分别检测患者标本中的谷氨酸、乳酸和葡萄糖含量,并结合患者预后进行分析。结果：中度昏迷组乳酸与谷氨酸值在手术后呈进行性下降,与术前比较,术后第2、3、4 天差异有统计学意义（P<0.05）,乳酸值的变化与谷氨酸变化趋势相近,与术前比较,在术后第3、4 天差异有统计学意义（P<0.05）,葡萄糖值与术前比较,术后第2、3、4 天差异有统计学意义（P<0.05）；重度昏迷组谷氨酸、乳酸和葡萄糖与术前比较,三者均在第4 天出现有统计学意义的变化。重度昏迷组谷氨酸测量值在各个观察点均高于中度昏迷组测量值（P<0.05）,乳酸值亦明显高于中度昏迷组测量值（P<0.05）,葡萄糖测量值两组术前测量值差异无统计学意义（P>0.05）,自术后第1 天始,中度昏迷组各个时间点测量值明显高于重度昏迷组。结论：结合患者的GCS 评分，应用微透析技术实时监测患者脑内谷氨酸、乳酸以及葡萄糖的含量变化，能很好的把握患者的病情，有效指导临床治疗。

英文摘要:

Objective: To apply microdialysis technique to patients with severe traumatic brain injury and to analyse the relationship between sustained brain glutamate,lactate and glucose and patients' conditions. Methods: A total of 32 patients with acute brain injury were selected, who had been hospitalized in Brain Surgery and ICU in our hospital from March 2006 to November 2009. According to GCS ,the patients were divided into severe and moderate coma groups. All the patients underwent emergency surgeries and were placed microdialysis probes under direct vision during surgery. The microdialysis probes were removed 4 days after implantation. The dialysates samples of the patients were collected and glutamic acid, lactic acid and glucose in the dialysates were detected and analysed according to the prognosis of the patients. Results: The moderate group of lactic acid and glutamate values coma after surgery decreased progressively, and preoperative, postoperative significantly 2,3,4 day (P <0.05), changes in lactate and glutamate similar trend, with the preoperative, the first 3,4 days after surgery were significantly (P <0.05), compared with the preoperative glucose value, 2,3,4 days after the first statistical difference Significance (P <0.05); Severe coma group of glutamate, lactate and glucose compared with the preoperative, three caught at the 4th day of significant change. Severe coma group of glutamate measured in all observation points higher than the moderate coma group measurements (P<0.05), lactate concentration was significantly higher than moderate coma group measurements (P <0.05), glucose levels were measured Preoperative measurements showed no significant difference (P>0.05), since the beginning of postoperative day 1, moderate coma group measured each time point was significantly higher than severe coma group. Conclusion: The combination of GCS score of patients, application of microdialysis in patients with real-time monitoring of glutamate, lactate and glucose content, is a very good grasp for patients, it can guide the clinical treatments.

查看全文查看/发表评论下载PDF阅读器

关闭