经颅多普勒监测高氧液对脑外伤后脑血管痉挛的作用  

The effect of hyperxia liquid on posttraumatic vasospasm in patients with traumatic brain injury using transcranial Doppler

作　　者：楚胜华[1] 袁先厚[1] 江普查[1] 吴静[1] 郭国炳[1] 

机构地区：[1]武汉大学中南医院神经外科,武汉430071

出　　处：《中华物理医学与康复杂志》2005年第1期41-44,共4页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的　分析脑外伤后脑血管痉挛 (CVS)的发生规律及经颅多普勒 (TCD)检测CVS的作用 ,并评价高氧液对脑外伤后CVS的治疗价值。方法　将 74例脑外伤后CVS患者分为治疗组 (高氧液治疗组 )3 2例和对照组 42例 ,分别于第 1天、3d、1周、2周通过TCD对双侧大脑中动脉 (MCA)及颈内动脉 (ICA)颅外段进行脑血流速度检测 ,分析比较CVS、动脉血氧分压 (PaO2 )、血氧饱和度 (SaO2 )、格拉斯哥昏迷评分(GCS)等生理及神经功能指标变化情况及最后治疗效果。结果　伤后 1～ 3d已开始出现血管痉挛 ,3～ 7d达峰值 ,14d已明显减轻 ;治疗组血氧分压及氧饱和度明显高于对照组 (P <0 .0 5 ) ;并且其血管痉挛的程度明显低于对照组 (P <0 .0 5 ) ;意识情况和预后均明显好于对照组 (P <0 .0 5 ) ;血管痉挛程度越重 ,病情越重 ,预后越差。结论　TCD是检测外伤后早期脑血管痉挛的有效方法 ,高氧液对纠正外伤后脑血管痉挛有显著疗效。Objective To study the role of transcranial Doppler (TCD) in early diagnosis of posttraumatic vasospasm in traumatic brain injury patients and in treatment effect monitoring of hyperxia liquid for this condition. Methods Seventy-four patients with posttraumatic vasospasm were divided into two groups. The control group (n=42) received the general treatment, while the treatment group (n=32) received the treatment of hyperxia liquid in addition to the general treatment. Their cerebral blood flow velocities of bilateral MCA and extra-cranial portion of ICA were monitored regularly by TCD, starting from the first day after head injury until 14th day. The changes of physiological and neurofunctional parameters in both groups were compared, including cerebral vasospasm(CVS),arterial blood oxygen pressure (PaO 2),arterial blood oxygen saturation (SaO 2), the Glasgow coma scale (GCS)and the ultimate effects of treatment as indicated by Glasgow outcome scale(GOS). Results Cerebral vasospasm occurred in 1 to 3 days and peaked to the 3 to 7 days after injury, then markedly relieved at 14 days after injury. After infusion of hyperxia liquid, the PaO 2 and SaO 2 in the treatment group were significantly higher than those of the control group. The degree of vasospasm was significantly higher in the control group than that in the treatment group. GCS and GOS of the treatment group were significantly higher than those of the control group. Poor outcome was common in patients with severe cerebral vasospasm. Conclusion Early posttraumatic vasospasm can be detected by TCD. High-oxygen liquid is effective for treating posttraumatic vasospasm.

关 键 词：脑外伤 脑血管痉挛 经颅多普勒 高氧液 

分 类 号：R651[医药卫生—外科学]