颅脑损伤患者脑细胞间液代谢物含量的变化及其临床意义

目的探讨颅脑损伤患者脑细胞间液中葡萄糖（Glu）、乳酸（Lac）、丙酮酸（Pyru）、甘油（Gly）、一氧化氮（NO）含量的变化及其临床意义。方法将微透析导管分别插入患者病灶半暗带区、相对正常脑组织区和腹部皮下组织收集微透析液，用生化分析仪测定Glu、Lac、Pyru、Gly、NO的变化，并计算Lac与Glu（UG）及Lac与Pyru（L／P）之比值。结果病灶半暗带区脑组织中Glu、Pyru、Gly的含量及L/G、L/P比值与相对正常脑组织中的相应值无显著性差异（P〉0.05），Glu的含量和坍比值均明显低于腹腔皮下组织的相应值（P〈0．01），Lac和NO浓度则明显高于正常脑组织和腹部皮下组织（P〈0．01）。结论微透析技术提供了一种实时监测颅脑损伤患者脑细胞间液生化指标的手段。患者脑组织间液中的生化指标和NO的含量变化可能与其预后密切相关。

Changes in cerebral Intercellular Fluid Metabolites and Their Clinical Significances in Patients with Craniocerebral Trauma

Objective To study the changes in the cerebral intercellular fluid metabolites and their clinical significances in patients with craniopcerebral trauma. Methods The catheters for microdialysis were punctured respectively into semi-dark band around the cerebral traumatic foci, relatively normal cerebral tissues and abdominal subcutaneous tissues to collect the intercellular fluid in 20 patients with craniocereabral trauma. The contents of glucose （Glu）, lactate（Lac）, pyruvate（Pyru）, glycerol（Gly） and NO in the collected intercellular fluid were determined by biochemical analysis instruments. The ratios of Lac to Glu and Lac/Pyru were calculated. Results There were no significant difference in the contents of Glu, Pyru, Gly and the ratios of Lac to Glu, and Lac to Pyru between the brain tissues around the traumatic foci and relatively normal cerebral tissues in the patients with craniocerebral trauma （P〉0.05）. The contents of Glu and Gly in the cerebral intercellular fluid were significantly lower than those in the abdominal subcutaneous tissues fluid （P〈0.01）, but the contents of Lac and NO in the cerebral tissues around the traumatic foci were significantly higher than those in the relatively normal cerebral tissues and abdominal subcutaneous tissues （P〈0.01）. Conclusion Microdialysis can provides for the real-time changes in the metabolites of cerebral and subcutaneous intercellular fluid in the patients with craniocerebral trauma. It is suggested that the some biochemical changes in the cerebral tissues may occur in the patients with craniocerebral trauma.