CN102018724A - Preparation method of medical artificial cerebrospinal fluid and application thereof - Google Patents
Preparation method of medical artificial cerebrospinal fluid and application thereof Download PDFInfo
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Abstract
The invention provides a preparation method of medical artificial cerebrospinal fluid and an application thereof, belonging to the fields of medical treatment and public health. The technical scheme of the invention is that: firstly, preparation prescription of the artificial cerebrospinal fluid includes 6.279g of sodium chloride, 0.216g of potassium chloride, 0.353g of calcium chloride, 0.488g of magnesium chloride, 1.932g of sodium bicarbonate, 0.6g of glucose, 0.358g of disodium hydrogen phosphate and 1000ml of distilled water; secondly, the preparation method includes the following steps: 1, disinfection; 2, thinner preparation; 3, artificial cerebrospinal fluid preparartion; and 4, storing; thirdly, application range includes the following diseases or conditions: (1) cleaning of craniocerebral injury and war wound dirt; (2) subarachnoid hemorrhage; (3) cerebral hemorrhage broken into the ventricle; (4) central nervous system infectious diseases; (5) cerebrospinal fluid fistula; and (6) washing of brain wound in brain operation.
Description
Technical field
The present invention relates to a kind of preparation and application of medical artificial cerebrospinal fluid, belong to medicine and hygiene fields.
Background technology
Cerebrospinal fluid is water white liquid, is filled in each ventricular system, brain pond, subarachnoid space, terminal cistern and the myelocoele.Cerebrospinal fluid is produced by the choroid plexus in the ventricular system, flow into subarachnoid space through median aperture of fourth ventricle and apertura lateralis, infiltrating through superior sagittal sinus by the pacchionian bodies in the brain dorsal part subarachnoid space at last is back in the vein, form the cerebrospinal fluid circulation thus, the generation of cerebrospinal fluid and absorption keep dynamic equilibrium.About 150 milliliters of the cerebrospinal fluid total amount of normal adult, its proportion is 1.003-1.008, pH7.33~7.34, CO
2Tension force 5.0~6.2kPa, partial pressure of oxygen 5.7kPa (43.0mmHg) contains inorganic ions, glucose and a small amount of protein, and cell seldom is mainly mononuclear cell and lymphocyte.Cerebrospinal fluid is to buffering, protection, nutrition, the transportation metabolite of brain and spinal cord and keep normal cranium and pressed crucial effects.The cerebrospinal fluid circulation is the peculiar anatomical physiology structure of nervous system, the particular problem that must face when being diagnosis and treatment central nervous system disease.
The character and the pressure of cerebrospinal fluid are subjected to influence of various factors, if pathological changes takes place the central nervous system, the metabolism disorder of neurocyte will change the character and the composition of cerebrospinal fluid; If the circulating path of cerebrospinal fluid is obstructed, intracranial pressure will increase.Therefore, usually to do lumbar puncture and draw examination of cerebrospinal fluid, to assist diagnosis; When serious disease takes place in the central nervous system, as subarachnoid hemorrhage, ventricles of the brain hematocele and infection, purulent meningitis etc., often the cycle is long, complication is many for classical conventional Therapeutic Method, and cerebrospinal fluid displacement becomes one of important treatment means day by day with its excellent curative.
Spontaneous subarachnoid hemorrhage (SAH) is one of modal disease of neural inside and outside section, and wherein to break hemorrhage be its most important reason to cerebral aneurysm.The treatment of cerebral aneurysm has challenge concerning the clinician.Subarachnoid space continues hematocele will cause serious cerebral vasospasm, and this is the key factor that influences cerebral aneurysm treatment prognosis.Existing a large amount of report, the position of cerebral vasospasm and the amount of bleeding of SAH have direct dependency, and the incidence rate of cerebral vasospasm and the order of severity thereof are obviously relevant with subarachnoid space hematocele amount.Generally acknowledged at present it is the contraction that material in the subarachnoid space hematoma causes tremulous pulse, behind the SAH in the cerebrospinal fluid hematocele many more, the persistent period is long more, the cerebral vasospasm incidence rate is high more.Key operation in the aneurysm surgery is that folder closes aneurysm neck and removes the interior hematocele of subarachnoid space, removes courageous and upright cerebrospinal fluid in early days, will effectively alleviate cerebral vasospasm.Because it is impossible that aneurysm clamp closes the hematocele of removing fully in the operation in the subarachnoid space, so postoperative continues the perfusion of artificial cerebrospinal fluid and replaces just necessary.
Spontaneous, traumatic or operation back intracranial infection is the FAQs of neural inside and outside section, treatment cycle is long, and easily repeatedly, the treatment cost is big, sequela is many, and complication such as cerebral hernia, cerebral infarction, hydrocephalus, marrowbrain arachnoiditis, polyneuritis, epilepsy and dementia easily take place.Its disability rate and mortality rate are all very high, and main cause is that inflammatory products is difficult to drain and the difficult blood brain barrier that sees through of most of anti-infectives in intracranial and the canalis spinalis.During the severe infection meningitis, a large amount of inflammatory exudates are covered in the brain surface, and be full of subarachnoid space and ventricular system, often be deposited on brain pond and perivascular space, cause cerebrospinal fluid secretion, circulation and malabsorption, pathological change such as the neuronal degeneration that cause intracranial hypertension, cerebral endarteritis, directly contacts with cerebrospinal fluid and meninges adhesion.Particularly ventricular system infects even empyema, and PD is swift and violent, and the conventional method treatment is felt simply helpless especially.And splash into tricorn with artificial cerebrospinal fluid through conduit this moment, conduit through waist Da Chi place goes out the inflammatory drainage of cerebrospinal fluid external again, replaceable like this patient's inflammatory cerebrospinal fluid, remove pathogen and harmful substances such as toxin, non-viable non-apoptotic cell residue and fibrin thereof, thereby environment is basicly stable in keeping; Regulate and the monitoring intracranial pressure, the control intracranial hypertension, treatment provides the time to guarantee to medicine, so often obtains beyond thought effect, existing a lot of successful case reports.By the Intraventricular administration, cerebrospinal fluid Chinese medicine concentration is increased, and make its uniform distribution, reduce systemic administration dosage and toxicity thereof, improve curative effect.
At present, medicine when injection in the clinical up cerebrospinal fluid displacement art of China, sheath, the still normal saline of extensive use 0.9%.Because ion composition and concentration, osmotic pressure, pH value and the cerebrospinal fluid of normal saline are widely different, theoretically, replace cerebrospinal fluid with normal saline and will cause new damage the existing cerebral tissue that damages.Normal saline can only a spot ofly use, and injects and be unfavorable for the physiological environment of cerebrospinal fluid in a large number.The pH value of normal saline can produce meta-acid sometimes, can produce obvious suppression to the vital center of brain stem, and severe patient can cause death.A Japanese scholar accompanies loyal face etc. to find in zoopery before surplus in the of 20 year, with normal saline flushing cerebral tissue dirt, causes the reaction of cerebral arteries expansion after-contraction earlier, cerebrospinal fluid cell number, protein, Cl occur with the capable Intraventricular perfusion of normal saline
-Increase, and sugar, Na+, K+, Ca
2+Reach pH value and significantly descend, then do not have above-mentioned phenomenon with homemade artificial cerebrospinal fluid repeated trials.Cardiovascular response when the Lin of infectious disease Institute for Medical Research of septic yanks in 1992 etc. have observed lasting Intraventricular perfusion artificial cerebrospinal fluid, the result shows and continues that low flow perfusion can carry that certain medicine directly enters the ventricles of the brain and the negative interaction that can not produce blood pressure and changes in heart rate.Calendar year 2001 Oka etc. is reported in the nerve endoscope operation and uses normal saline as flushing liquor, and postoperative patient often has performances such as headache, hyperpyrexia and stiffness of the neck; And low grade fever only appears in the patient with the artificial cerebrospinal fluid lavation in the art.Reports such as Enomoto in 2005 are exposed in the environment of normal saline can cause the apoptosis of people's astrocyte, and does not see the spider cell apoptosis under the artificial cerebrospinal fluid environment.Doi in 2007 etc. think when cerebral cortex washed, and find that the flushing liquor of different components is to cause the bullate factor of brain water.Because ion concentration, pH value and the crystalloid osmotic pressure of artificial cerebrospinal fluid are similar to human cerebrospinal fluid, avoided making its clinical practice safer with the dabbling many side effect of normal saline, some treatment of diseases of central nervous system is undoubtedly a major progress.Therefore, artificial cerebrospinal fluid is than normal saline flushing liquor more suitably.
Summary of the invention
The invention provides a kind of preparation method of artificial cerebrospinal fluid, preparation process is simple, and hospital internal just can be finished preparation or produce in batches.The technical scheme that the present invention takes is:
One, artificial cerebrospinal fluid preparation prescription: with normal waist Da Chi cerebrospinal fluid composition and content as the preparation foundation, its prescription is sodium chloride 6.279g, potassium chloride 0.216g, calcium chloride 0.353g, magnesium chloride 0.488g, sodium bicarbonate 1.932g, glucose 0.6g, sodium hydrogen phosphate 0.358g, distilled water 1000ml.
Two, preparation method:
1, sterilization to the equipment disinfection of needs, is made aseptic process to needed raw material, scientifically prepares artificial cerebrospinal fluid, makes its electrolyte and acid-base value be in normal and strict sterilization.
2, one of conical flask is got in the diluent preparation, sodium chloride 6.279g, potassium chloride 0.216g, calcium chloride 0.353g, magnesium chloride 0.488g, sodium bicarbonate 1.932g, glucose 0.6g, sodium hydrogen phosphate 0.358g, distilled water 1000ml, stir, the solution for preparing is through microporous membrane filtration, at 105 ℃ of sterilization 40min.
3, diluent 1000ml is got in the artificial cerebrospinal fluid preparation, feeds to contain 95%O
2, 5%CO
2Mist is to saturated getting final product, and pH 7.3~7.4, add a small amount of albumin 0.2g, packing 250 or 500ml.
4, storage, the holding time, storage temperature was 37 ℃ of body temperatures in 1 hour.Holding time surpasses 1 hour, should leave in earlier under-4 ℃ the environment, and the time spent shifts to an earlier date half an hour and take out, be placed on 37 ℃ environment, with the artificial cerebrospinal fluid of method for preparing, outward appearance is limpid, sugar sxemiquantitative (Benedict method) 2.2~2.8mmol/l, chloride 130~140mmol/l.
Three, range of application:
Mainly be applicable to following disease or situation.(1) head trauma injures the cleaning of war wound dirt; (2) subarachnoid hemorrhage; (3) cerebral hemorrhage breaks into the ventricles of the brain; (4) central nervous system infection disease; (5) cerebrospinal fluid fistula; (6) flushing of craniocerebral operations midbrain wound surface.In application process, the untoward reaction of artificial cerebrospinal fluid replacement is few and light, but still exists potential dangers such as intracranial hemorrhage, intracranial infection.For this reason, the treatment of using artificial cerebrospinal fluid displacement the time to accomplish following some: (1) scientifically prepares artificial cerebrospinal fluid, makes its electrolyte and acid-base value be in normal and strict sterilization; (2) catheter diameter is 2mm, and front end is established 2 side openings in addition, establishes switch valve and anti-backflow device on the drainage tube; (3) tricorn drain in advance, drainage speed is controlled in the 2ml/min, treats that ventricles of the brain pressure is about 1.47kPa (150mmH
2O) time, the waist of going is again worn the subarachnoid space drain, in case cause cerebral hernia or intracranial hemorrhage; (4) control input and drainage speed be 0.5-1.0ml/min (10-20 drips/min), the speed that artificial cerebrospinal fluid splashes into the ventricles of the brain must not surpass the speed that canalis spinalis is drawn, and tightly monitors cerebral, the maintenance cerebrospinal pressure is about 1.47kPa; (5) artificial cerebrospinal fluid faces the time spent, can add an amount of urokinase, Low molecular heparin, methylprednisolone, antibiotic or nerve cell-protective agents etc. as one sees fit; (6) person that the noncommunicating hydrocephalus occurs should not adopt waist cisternal puncture drainage; (7) normally the live away from home conditioned pathogen, particularly staphylococcus epidermidis of skin can be invaded intracranial along conduit through otch, cause secondary infection, so the aseptic management of surgical drainage district skin are most important, and infusion time surpasses 3 days will add antibiotic in the infusion liquid.(8) can not splash into or import when finishing when artificial cerebrospinal fluid, should recover to external drainage; (9) generally through the cerebrospinal fluid displacement of 5-10d, clear when the courageous and upright cerebrospinal fluid color of external drainage, the drain liquid measure is less than the input quantity of every day, and the CT check is shown can pull out drainage tube when ventricles of the brain hematocele is removed substantially, finishes the artificial cerebrospinal fluid replacement; If the central nervous system infection particularly ventricles of the brain infects, answer proper extension artificial cerebrospinal fluid and antibiotic lavation treatment time.(10) interim using artificial cerebrospinal fluid should be heated to about 37 ℃.
The specific embodiment:
Embodiment 1, ventricles of the brain irrigation, waist Da Chi drain: (1) cornu frontale ventriculi lateralis puncture in advance, silica gel catheter is inserted in the tricorn, slowly to external drainage courage and uprightness or inflammatory cerebrospinal fluid.When ventricles of the brain pressure drop to 1.47-1.76kPa (150-180mmH
2O) time, connect artificial cerebrospinal fluid infusion bottle (high position exceeds ventricles of the brain plane 18-20cm).(2) capable again waist cisternal puncture art, silica gel catheter is inserted lumbar vertebra 3~4 horizontal cavitas subarachnoidealis spinalis, connects drainage bag (low level), to external drainage courage and uprightness or inflammatory cerebrospinal fluid, the intrinsic pressure 1.47-1.76kPa (150-180mmH that also is controlled at of cavitas subarachnoidealis spinalis
2O).(3) alternately to Intraventricular input artificial cerebrospinal fluid, and, replace 2-3 time every day, import the about 50ml of artificial cerebrospinal fluid at every turn from the cavitas subarachnoidealis spinalis drain.System is for continuing closed type device.
Embodiment 2, a side tricorn irrigation, the drain of offside tricorn: row bilateral cornu frontale ventriculi lateralis puncture Intraventricular is inserted silica gel catheter, one side connects artificial cerebrospinal fluid infusion bottle (high position), offside connection drainage bag (low level, but still be higher than the about 10cm in ventricles of the brain plane).System is for continuing closed type device.Continue to splash into artificial cerebrospinal fluid.Be fit to the case that ventricles of the brain hematocele or Intraventricular infect.
The flushing of embodiment 3, brain pond: aneurysm clips closes to be opened side and splits pond, internal carotid artery pond and chiasmatic cistern in the art, and exposes M1 section and A1 section, and aneurysm clamp closes the back and inserts thin silica gel syringe pipe at chiasmatic cistern, inserts drainage tube at cistern of lateral sulcus.How higher because of aneurysm patient intracranial pressure, folder closes the conventional ventricular drainage tube of keeping somewhere in the art.Postoperative began to carry out washing in the brain pond with artificial cerebrospinal fluid the same day, adjusted flushing speed gradually, 20~30ml/h.Control flushing speed with precision infusion set, or pump into the 50ml micro pump.Per hour measure the discrepancy amount, avoid causing cerebral hernia because of beverage product.If brain pond high density shadow disappears during the check Cranial Computed Tomography, total cellular score is reduced to 1 * 10 in the cerebrospinal fluid of drain
8After/L is following, can extract drainage tube.Drainage time surpassed for 1 week, added gentamycin 10,000 U/d in the flushing liquor, with prevention infection.The course of treatment of douche therapy is generally at 5~10d in the brain pond.
Keep somewhere displacement method in embodiment 4, the waist Da Chi DLC sheath.By the lumbar puncture routine operation, getting L4~5 gaps is the 1st pin, after waist is worn successfully conduit is slowly inserted 3~4cm in the waist pond by nook closing member, and seeing has courageous and upright CSF to ooze in the conduit, and inlying catheter is extracted lumbar puncture needle.Conduit outer termination tube for transfusion joint connects tee T and outer connects an intracranial pressure table in the joint, survey cerebral (observing intracranial pressure every 0.5h in the replacement process changes), and the connection 90cm of straight peen place of tee T has the transfusion device sebific duct of speed governing knob, closes tee T.Far-end inserts and has exhaust needle sterilization empty bottle.It is that point of puncture is inserted conduit (noticing that conduit is to the placement of lumbosacral region direction) that the 2nd pin is got L2~3 gaps, and the outer end joint connects and contains the artificial cerebrospinal fluid transfusion device.The whole closed that is replaced into.After 2 conduits are inserted successfully, but patient's horizontal position, after the no discomfort, regulate simultaneously input and output speed (20/min), the input artificial cerebrospinal fluid is emitted with isodose simultaneously and is contained the blood cerebrospinal fluid, reaches the turnover balance, the about 300mL of each displacement, about 4~5h finishes.Survey intracranial pressure after displacement finishes, remove the joint of transfusion device and output duct, the also wrapping of aseptic process outer end, two conduits sealing back joint.Replace once every day as stated above.
Embodiment 5, waist cisternal puncture displacement method repeatedly.After single needle punctures successfully, emit the courageous and upright cerebrospinal fluid of about 10-30ml, the artificial cerebrospinal fluid of the basic equivalent of reinjecting is to reach the displacement purpose.Repeated localised puncture easily causes patient's misery, and the chance that infects increases.It is little to aspirate each replacement amount with single needle, and the hematoclasis material is difficult for excreting, and cerebral fluctuation simultaneously is big, might bring out cerebral hernia etc.
Claims (5)
1. the preparation method of medical artificial cerebrospinal fluid and application is characterized in that artificial cerebrospinal fluid preparation prescription is: sodium chloride 6.279g, potassium chloride 0.216g, calcium chloride 0.353g, magnesium chloride 0.488g, sodium bicarbonate 1.932g, glucose 0.6g, sodium hydrogen phosphate 0.358g, distilled water 1000ml.
2. the preparation method of medical artificial cerebrospinal fluid according to claim 1 and application is characterized in that the preparation method of artificial cerebrospinal fluid has following steps: 1, sterilization, 2, diluent preparation, 3, the artificial cerebrospinal fluid preparation, 4, storage.
3. the preparation method of medical artificial cerebrospinal fluid according to claim 1 and application is characterized in that the diluent preparation process is: get one of conical flask, sodium chloride 6.279g, potassium chloride 0.216g, calcium chloride 0.353g, magnesium chloride 0.488g, sodium bicarbonate 1.932g, glucose 0.6g, sodium hydrogen phosphate 0.358g, distilled water 1000ml stirs, the solution for preparing is through microporous membrane filtration, at 105 ℃ of sterilization 40min.
4. the preparation method of medical artificial cerebrospinal fluid according to claim 1 and application is characterized in that the artificial cerebrospinal fluid process for preparation is: get diluent 1000ml, feeding contains 95%O
2, 5%CO
2Mist is to saturated getting final product, and pH7.3~7.4 add a small amount of albumin 0.2g and get final product.
5. the preparation method of medical artificial cerebrospinal fluid according to claim 1 and application is characterized in that the holding time in 1 hour, and storage temperature is 37 ℃; Holding time surpasses 1 hour, should leave in earlier under-4 ℃ the environment, and the time spent shifts to an earlier date half an hour takes out, be placed on 37 ℃ environment.
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CN105319214A (en) * | 2015-11-30 | 2016-02-10 | 四川大学华西第二医院 | Cerebrospinal fluid detection device used for intraspinal anesthesia |
WO2016059162A1 (en) * | 2014-10-15 | 2016-04-21 | P&X Medical Bvba | Therapeutic applications of artificial cerebrospinal fluid and tools provided therefor |
CN105687236A (en) * | 2016-03-14 | 2016-06-22 | 中山大学附属第医院 | Medical artificial inner ear perilymph fluid, preparation method and application thereof |
CN107132089A (en) * | 2017-04-28 | 2017-09-05 | 遵义医学院附属医院 | A kind of preparation method of medical cerebrospinal fluid quality-control product |
CN108310008A (en) * | 2018-01-09 | 2018-07-24 | 中国人民解放军陆军军医大学第附属医院 | Application of the colloidal gold in preparing artificial cerebrospinal fluid reagent |
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US11541175B2 (en) | 2014-10-15 | 2023-01-03 | P&X Medical Nv | Therapeutic applications of artificial cerebrospinal fluid and tools provided therefor |
CN105319214A (en) * | 2015-11-30 | 2016-02-10 | 四川大学华西第二医院 | Cerebrospinal fluid detection device used for intraspinal anesthesia |
CN105687236A (en) * | 2016-03-14 | 2016-06-22 | 中山大学附属第医院 | Medical artificial inner ear perilymph fluid, preparation method and application thereof |
CN107132089A (en) * | 2017-04-28 | 2017-09-05 | 遵义医学院附属医院 | A kind of preparation method of medical cerebrospinal fluid quality-control product |
CN108310008A (en) * | 2018-01-09 | 2018-07-24 | 中国人民解放军陆军军医大学第附属医院 | Application of the colloidal gold in preparing artificial cerebrospinal fluid reagent |
CN108310008B (en) * | 2018-01-09 | 2020-12-18 | 中国人民解放军陆军军医大学第一附属医院 | Application of colloidal gold in preparation of artificial cerebrospinal fluid reagent |
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CN111214486A (en) * | 2020-02-28 | 2020-06-02 | 西安交通大学医学院第一附属医院 | Magnesium-rich artificial cerebrospinal fluid and preparation method and application thereof |
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Application publication date: 20110420 |