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目的探讨颅脑损伤患者脑脊液(CSF)和血浆葡萄糖(G lu)、乳酸水平动态变化的临床意义。方法将70例颅脑损伤患者依GCS评分结果分为轻中型组(A组)40例和重型组(B组)30例,监测入院后24、48 h及1周时CSF及血浆G lu、乳酸水平的动态变化,并进行统计分析,探讨其意义。结果入院后24 h 2组患者的血糖含量明显高于其他时相,B组各时相血糖均高于A组(P均<0.01);CSF中G lu随着血糖浓度的改变而变化,上升速度较血糖缓慢,且1周时2组浓度无显著差异(P>0.05);相对CSF中G lu浓度波动,乳酸变化较小,仅在24 h时高于其他时相(P<0.01)及B组高于A组(P<0.05);24 h时血浆乳酸水平升高,余时相无明显波动;CSF中G lu水平明显低于血浆水平,乳酸显著高于血浆水平(P<0.01)。结论轻、中型与重型颅脑损伤后CSF及血浆中G lu和乳酸水平呈现不同的、明显的动态变化,CSF中G lu及乳酸水平与血液有很大差异,乳酸可能参与了中枢神经系统的能量代谢。
Objective To investigate the clinical significance of cerebrospinal fluid (CSF), plasma glucose (G lu) and lactic acid in patients with brain injury. Methods Seventy patients with traumatic brain injury were divided into 40 cases in light and medium group (group A) and 30 cases in severe group (group B) according to GCS score. The levels of CSF and plasma G lu, Lactic acid levels of dynamic changes, and statistical analysis to explore its significance. Results The blood glucose levels of patients in two groups at 24 h after admission were significantly higher than those in other phases. The blood glucose in each phase in group B was significantly higher than that in group A (P <0.01), and the level of lu in CSF was increased with the change of blood glucose concentration (P> 0.05). Compared with the other phases (P <0.01), the changes of G lu concentration in the relative CSF were less and the change of lactate was smaller at 24 hours B group was higher than that of A group (P <0.05). The level of plasma lactate increased 24 hours later, while the other phase had no obvious fluctuation. The level of G lu in CSF was significantly lower than that in plasma and lactic acid was significantly higher than that in plasma (P <0.01) . Conclusions The levels of G lu and lactic acid in CSF, plasma and plasma of mild, moderate and severe craniocerebral injury show different and obvious dynamic changes. The levels of G lu and lactate in CSF are greatly different from those in blood. Lactic acid may be involved in the central nervous system Energy Metabolism.