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1998 Fiscal Year Final Research Report Summary

Continuous monitoring of focal brain and cerebrospinal fluid oxygen metabo-lism, acid-base balance, excitatory amino-acid, temperature, and blood flow in patients with severe head injury : Effects of intracranial hypertension, global ischemia, and hypothermia treatment

Research Project

Project/Area Number 09470301
Research Category

Grant-in-Aid for Scientific Research (B)

Allocation TypeSingle-year Grants
Section一般
Research Field Cerebral neurosurgery
Research InstitutionKYORIN UNIVERSITY SCHOOL OF MEDICINE

Principal Investigator

SAITO Isamu  KYORIN UNIVERSITY SCHOOL OF MEDICINE,NEUROSURGERY,PROFESSOR, 医学部, 教授 (20186927)

Co-Investigator(Kenkyū-buntansha) IIJIMA Katuhiko  KYORIN UNIVERSITY SCHOOL OF MEDICINE,ANESTHESIOLOGY,ASSISTANT, 医学部, 助手 (10193129)
Project Period (FY) 1997 – 1998
Keywordssevere head injury / cerebral oxygen metabolism / cerebral acid-base balance / cerebral blood flow / hypothermia / hyperventilation / cerebrospinal fluid / jugular blood
Research Abstract

Continuous monitoring of cerebral acid-base balance and oxygen metabolism has been introduced in neurointensive care settings. The hypothesis of this study utilizing multimodal neuromonitoring modali-ties is that hyperventilation and hypothermia improve cerebral acidosis through prevention of cerebralischemia aggravation in patients with severe head injury.
Patients and Methods : Continuous monitoring of cerebrospinal fluid (CSF) pH, PCO_2, HCO_<3->, base excess (BE), P0_2, S0_2, and temperature, and lactate and pyruvate (La and Py) measurements were conducted in 13 patients with severe head injury. Temperature-corrected CSF parameters were correlated with those in the jugular blood including oxygen saturation (SjO_2), regional oxygen saturation (rSO_2), intracranial pressure (ICP) and cerebral perfusion pressure (CPP), jugular blood temperature (Tjb), and endtidal PCO_2 (PetCO_2). Therapeutic significance of hyperventilation and hypothermia was evaluated.
Results : 1. CSF acidosis was o … More bserved in all cases due to increased CSF PCO_2 and/or decreased CSF HCO_<3->, and tended to associate with abnormal ICP and/or CPP or ischemic episodes indicated by CSF P0_2 and S0_2, rSO_2, and/or SjO_2 during monitoring. 2. It was more obvious in CSF than in jugular blood that increased PCO_2, La and Py, and/or decreased HCOy resulted in decreased BE and pH.3. Decreased CSF P0_2 and S0_2 only associated with severe CSF acidosis. 4. Hyperventilation : Decreased PetCO_2 did not always closely correlate with CSF PCO_2 decrease and CSFpH increase. 5. Hypothermia : There were negative correlations of Tjb with CSF pH and S0_2 in all cases.
Conclusions : CSF acidosis caused by increased CSF PCO_2, La and Py and/or decreased HCO_<3-> tended to associate with abnormal ICP and CPP, and desaturation indicated by CSF S0_2, rSO_2, and/or SjO_2.Hypothermia rather than hyperventilation tends to improve cerebral acidosis and ischemia.
Future direction : Simultaneous monitoring of cerebral blood flow, oxygen metabolism, acid-base bal-ance, and excitatory amino acids in the brain parenchyma would be further clarification of the efficacy of neuroprotective treatments in cases of severe head injuries. Less

  • Research Products

    (30 results)

All Other

All Publications (30 results)

  • [Publications] 塩貝敏之: "重症脳障害患者の脳酸素代謝、脳潅流圧と頚静脈血液温の連続モニタリング" 集中治療. 7. 1215-1217 (1995)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] 塩貝敏之: "脳循環動態、脳酸素代謝、脳機能よりみた重症頭部外傷患者の頭蓋内圧亢進に対する治療法の比較." 神経外傷. 18. 48-54 (1995)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] Shiogai T: "Hemodynamic, metabolic, and neuronal effects of intravenous glycerol or mannitol in patients with severe head injury." J Neurotrauma. 12. 401 (1995)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] Shiogai T: "Hemodynamic, metabolic, and intracranial pressure correlations with quantitative EEG in comatose patients with severe head injury-effects of hyperventilation." Electroenceph Clin Neurophysiol. 97. S246 (1995)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] 塩貝敏之: "重症脳障害患者の髄液酸塩基平衡と酸素代謝の連続モニタリング" 集中治療. 8. 1281-1282 (1996)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] Shiogai T: "Continuous monitoring of cerebrospinal fluid acid-base balance and oxygen metabolism in patients with severe head injury-Therapeutic effects of hyperventilation and hypothermia for cerebral acidosis." J Neurotrauma. 14. 277 (1997)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] 塩貝敏之: "重症頭部外傷患者の髄液と頚静脈血の酸塩基平衡と乳酸・ピルビン酸." 集中治療. 9. 1357-1358 (1997)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] 塩貝敏之: "重症脳障害患者の脳アシドーシスと酸素代謝障害の病態と治療-髄液酸塩基平衡, 脳酸素代謝, 頚静脈血液温と頭蓋内圧の連続モニタリングから." 脳循環代謝. 10. 118-119 (1998)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] Shiogai T: "Neurochemical Monitoring in the Intensive Care Unit" Tsubokawa T, Marmarou A, Robertson C, Teasdale G, 7 (1995)

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      「研究成果報告書概要(和文)」より
  • [Publications] Shiogai T: "he Society for Treatment of Coma Vol.5," Yoshimoto T, Kanno T, 11 (1977)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] Shiogai T: "Neurochemical Monitoring in the Intensive Care Unit II" Bullock, Marmarou A(in press), (1999)

    • Description
      「研究成果報告書概要(和文)」より
  • [Publications] Shiogai T,Sato E,Noguchi A,Saito I: "Vasoreactive effects of cerebral oxygen metabolism and neuronal function in patients with severe head injury-continuous monitoring of transcranial Doppler (TCD), jugu-lar bulb venous oxygen saturation (SjO2), and quantitative EEG (qEEG)" Neurosonology. 6. 75-75 (1993)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Sato E,Noguchi A,Takeuchi K,Saito I: "Vasoreactive assessment of cerebral circulation and oxygen metabolism, and neuronal function in patients with severe head injury" Advances in Neurotrauma Research. 5. 25-29 (1993)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Noguchi A,Sato E,Saito I: "(Abstract) Vasoreactive evaluation of transcranial Doppler moni-toring related to cerebral oxygen metabolism and neuronal function in patients with severe head injury" Ultrasound in Medicine and Biology. S29-S29. (1994)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Noguchi A,Sato E,Saito I: "(Abstract) Vasoreactive evaluations of transcranial Doppler moni-toring related to disturbances of cerebral oxygen metabolism and neuronal function in patients with severe head injury" Cerebrovascular Diseases. 4 (S3). 13-13 (1994)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Noguchi A,Sato E,Saito I: "(Abstract) Significance of continuous TCD monitoring in patients with severe brain damage : In relation to intracranial hypertension, cerebral ischemia, and neuronal dys-function" Neurosonology. 7. 118-118 (1994)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T: "Cerebral blood flow and metabolism and cerebrospinal fluid Neurotransmitters in the persis-tent vegetative state" The Society for Treatment of Coma. 3. 37-46 (1995)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Nara I,Hara M,Saito I: "(Abstract) Hemodynamic, metabolic, and neuronal effects of intrave-nous glycerol or mannitol in patients with severe head injury" J Neurotrauma. 12. 401-401 (1995)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Nara I,Tomita Y,Sato E,Hara M,Saito I: "(Abstract) Changes of cerebral blood flow velocity pulsatility during hyperventilation in patients with severe head injury : correlations with cerebrovascular resistance, intracranial pressure, and cerebral oxygen metabolism" J Neuroimaging. Suppl 2 Vol.5. S70-S70 (1995)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Nara I,Hara M,Takeuchi K,Saito I: "(Abstract) Hemodynamic, metabolic, and intracranial pressure correlations with quantitative EEG in comatose patients with severe head injury -effects of hyperventilation" Electroencephalography and Clinical Neurophysiology. 97. S246 (1995)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Nara I,Sato E,Saito I: "(Abstract) Relationships between cerebral blood flow velocity pulsatility and cerebrovascular resistance, intracranial pressure, and cerebral oxygen metabolism during hyperven-tilation" Neurosonology. 8. 149-149 (1995)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Yonamine Y,Hara M,Saito I: "( Abstract) Hemodynamic evaluation of cerebrovascular dis-eases based on blood flow volume estimated by power Doppler imaging" Cerebrovascular Disease. 6 (Suppl 2). 156-156 (1996)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Nara I,Saruta K,Hara M,Saito I: "(Abstract) Continuous monitoring of cerebrospinal fluid acid-base balance and oxygen metabolism in patients with severe head injury -Therapeutic effects of hyperventilation and hypothermia for cerebral acidosis" J Neurotrauma. 14. 277 (1997)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Nara I,Shiogai T,Hara M,Saito I: "Comparative effects of hypothermia, barbiturate, and osmotherapy for cerebral oxygen metabolism, intracranial pressure, and cerebral perfusion pressure in patients with se-vere head injury" Acta Neurochir. Suppl 71. 22-26 (1998)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Sato E,Fujii Y,Takeuchi K,Saito I: Continuous monitoring of trannscranial Doppler, jugular venous oxygen saturation, and quantitative EEG in severe head injury. In Nakamura N,Hashimoto T,Yasue M (Eds), Recent Advances in Neurotraumatology, Tokyo, Springer-Verlag, 297-300 (1993)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Noguchi A,Sato E,Saito I: Multimodal evaluation of cerebral oxygen metabolism distur-bances related to hyperventilation in patients with severe head injury. Intracranial Pressure VI. Tokyo/Berlin, Springer-Verlag, 372-375 (1994)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Noguchi A,Sato E,Saito I: Multimodal evaluation of cerebral oxygen metabolism distur-bances in patients with severe head injury : Special reference to cerebrovascular CO2 Reactivity. Tsubokawa T,Marmarou A,Robertson C,Teasdale G (Eds.) Neurochemical Monitoring in the Intensive Care Unit, Tokyo, Springer, 164-171 (1995)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Nara I,Shiogai T,Tanaka N,Tokitsu M,Saito I: Bilateral simultaneous monitoring of regional cere-brovascular oxygen saturation using near-infrared spectroscopy. Tsubokawa T,Marmarou A,Robertson C,Teasdaie G(Eds.), Neurochemical Monitoring in the Intensive Care Unit Tokyo, Springer, 218-225 (1995)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Nara I,Tomita Y,Saito I: Factors affecting prolongation of consciousness disturbance in patients with severe head injury : Analysis of cerebral circulation and metabolism, intracranial pressure, cerebral neuronal function, and systemic factors in the acute stage. Yoshimoto T,Kanno T (Eds), The Society for Treatment of Coma Vol. 5 Neuron Publishing Co., Ltd., Tokyo, 77-88 (1997)

    • Description
      「研究成果報告書概要(欧文)」より
  • [Publications] Shiogai T,Nara I,Saruta K,Hara M,Saito I: Continuous monitoring of cerebrospinal fluid acid-base balance and oxygen metabolism in patients with severe head injury : pathophysiology and treatments for cerebral acidosis and ischemia. Bullock R (Ed) Neurochemical Monitoring in the Intensive Care Unit, II New York, Springer-Verlag(in press), (1999)

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      「研究成果報告書概要(欧文)」より

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Published: 1999-12-08  

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