脑伤后脑动脉痉挛的监测研究  

HEMORRHEOLOGICAL STUDY ON POSTIRAUMATIC CEREBEAL ARTERIAL SPASM

作　　者：曾力[1] 李讯[1] 程林[1] 李开慧[1] 柴建康 匡永勤[1] 黄茂清[1] 胡威夷[1] 

机构地区：[1]成都军区总医院神经外科,成都610083

出　　处：《西南国防医药》2000年第5期264-267,共4页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的:用无创的经颅多普勒(TCD)连续监测创伤后脑动脉痉挛的发病率和临床特征,并确定血液流变学因素对TCD诊断脑动脉痉挛的影响。方法:对135例GCS计分为3～15分的颅脑损伤病人连续进行TCD监测,同时检验血液流变学指标。结果:64例(47.4％)病人有脑动脉痉挛(轻度32例,中度29例,重度3例),1例重度痉挛者发展成为MCA供血区的脑梗塞。无痉挛组、轻度痉挛组和中～重度痉挛组之间的血液粘滞度无显著性差异,排除了血液流变学因素对用TCD诊断创伤性脑动脉痉挛的影响。脑动脉痉挛与CT发现脑池积血或血性脑积液显著相关。脑电图异常与脑动脉痉挛显著相关。结论:脑伤性脑动脉痉挛是颅脑损伤后的常见并发症,个别病例动脉痉挛的严重性与动脉瘤性蛛网膜下腔出血相当。连续的TCD监测能够及时无创地诊断创伤性脑动脉痉挛、决定治疗策略以防止动脉痉挛导致的缺血性脑损伤。Objective: To investigate the incidence and features of posttraumatic cerebral arterial spasm and determine effects of hemorrhelogical factors on diagnosis by transcranial Doppler (TCD) ultrasound. Method: 135 patients suffering from head injury with Glasgow coma scale score ranging from 3 to 15 scores were monitored continuously by TCD ultrasound and their features of hemorrheology were measured. Result: Vasospasm was found in 64 patients (47.4%), including 32 mild, 29 moderate and 3 severe vasospasm. Among them, one with severe vasospasm developed into infraction in MCA areas. No significant difference of blood viscosity was found among subjectsl without vasospasm, and ones with mild, moderate and evere vasospasm, which indicating that hemorrhelogical factors did injury. Significant correlation was identified between the vasospasm and cisternal hemorrhage on CT scan or the amount of blood in cerebrospinal fluid. There was also a significant correlation between abnormal EEG and vasospasm. Conchusion: Posttraumatic cerebral arterial spasm is a common complication after head injury and in some cases, it is as sever as aneurysmal subarachnoid hemorrhage. Continous TCD monitioring makes it possible to diagnosis posttraumatic cerebral arterial spasm noninvasively, decide the correct therapy and prevent ischemic brain damage from vasospasm.

关 键 词：脑动脉痉挛 经颅多普勒 血液流变学 颅脑损伤 

分 类 号：R82[医药卫生—临床医学]