颅脑损伤后脑脊液、血液中碳酸氢根、糖、电解质、微量元素含量的研究

目的探讨颅脑损伤后早期脑脊液、血液中电解质、微量元素、糖、碳酸氢根含量变化及临床意义。方法将1999年1月-2002年1月住院病人按GCS进行分型,并于24 h、72 h采集各型病人受检标本,对血液和脑脊液中碳酸氢根、糖、电解质和微量元素进行测定。结果脑脊液K 、Na 低于血清中K 、Na-,受伤程度对两者并无影响。脑脊液中Ca~(2 )含量与脑损伤程度呈正相关,而血清中Ca~(2 )含量则与脑损伤程度呈负相关。锌、镁在脑脊液及血液中含量均呈下降,且与损伤程度呈正相关;重度以上损伤可致脑脊液、血液中磷离子降低。3 d后血糖仍未恢复正常易产生并发症,故应及时降糖。碳酸氢根浓度则与脑损伤无相关性。结论通过测定电解质及微量元素含量与变化,可作为判断伤情、指导治疗、预防并发症的参考依据,对抢救中、重度以上脑损伤病人具有重要意义。

Determinations of bicarbonate, glucose, electrolyte, microelement in cerebrospinal fluid and serum after brain injury

objective To explore early changes of electrolyte, glucose, microelement, bicarbonate contained in cerebrospinal fluid (CSF) and serum after brain injury. Methods 90 patients admitted from January 1999 to January 2002 were classified into 3 groups by the GCS, where the contents of electrolyte, glucose, microelement, bicarbonate in CSF and serum were examined at hour 24 and hour 72 respectively. Results The levels of K and Na- in CSF were lower than that in serum, which is not correlated with the degree of brain injury. Ca2 contained in CSF was positively associated with the degree of brain injury but negatively in serum. The levels of Zn2 and Mg2- were found to decrease in the CSF and serum, which was positively correlated with the degree of brain injury. The levels of phosphorus were reduced in the CSF and serum in those with severe brain injury. If the level of glucose was significantly higher and did not reduce to normal in 3 days, the patients were vulnerable to complications. Bicarbonate was not significantly correlated with brain injury. Conclusion The determinations of electrolyte, microelement, and glucose, bicarbonate in the CSF and serum, contributing a lot to the judgment of injury conditions, therapeutic instructions and prevention of complications, are of great importance in rescuing and treating patients with severe brain injury.