颅脑损伤后TCD变化与伤情及CT和预后的研究  

Study of The TCD Changes and Its Correlation with Clinical Features,CT Findings and Prognosis in Patients with Head Injury

作　　者：戚建军[1] 鲍文公[2] 张瑞剑[1] 云强[1] 

机构地区：[1]内蒙古自治区医院神经外科,内蒙古呼和浩特010017 [2]华中科技大学同济医学院附属同济医院神经外科,湖北武汉430030

出　　处：《内蒙古医学杂志》2005年第2期110-114,共5页Inner Mongolia Medical Journal

摘　　要：目的 :探讨颅脑损伤后脑血管多普勒 (TCD)的表现及变化规律与伤情及预后的关系。方法 :选择 4 8例伤后 2 4h入院的成年患者 ,伤后行TCD检测及CT检查并记录格拉斯哥伤情评分 (GCS)。 4 4例病人颅脑损伤后 3个月～半年追踪随访 ,记录格拉斯哥预后评分 (GOS)。结果 :通过TCD检测 ,脑外伤后 1～3d已开始出现血管痉挛 ,6～ 8d达峰值 ,13～ 15d明显减轻 ,不同时间段CVS的发生率及程度明显不同 (P <0 . 0 1) ;GCS与TCD变化有关 ,重伤组血管痉挛的发生率明显高于轻伤组 (P <0 . 0 1) ,不论是轻伤组还是重伤组 ,TCD表达值均 6～ 8d达高峰 ;不同CT分级发生血管痉挛有显著性差异 (P <0. 0 1) ,CT之Ⅰ～Ⅲ级血管痉挛的发生率有增加趋势 ,而Ⅳ级有下降趋势 ,tSAH越重 ,血管痉挛发生率越高 ,程度越重 ;伤后 6～ 8d ,13～ 15dTCD的变化与GOS有关 (P <0 . 0 1) ,血管痉挛程度越重 ,时间越长 ,则预后越差。结论 :TCD无创、方便、连续且重复性好 ,有利于早期发现血管痉挛发生及严重程度 。Objective:To investigate the changes of TCD in patients with head in juries and its relationship between the CT,GCS and outcomes of these patients.Methods:Data from 48 patients who were admitted within 24～48 hrs after head injury and were analyzed retrospectively.TCD,GCS as well as CT findings were recorded.44 patients after headinjury were traced back and recorded GOS in 3～6 months.Results:The incidence and severity of cerebral vasospasm were significantly different from each other 1～3,6～8 and 13～15 days after head injury by TCD (P<0 01).Cerebral vasospasm occurred 1～3 days after head injury and reached to the peak in the 6～8 day,then markedly relieved 13～15 days after head injury.GCS was closely related to the changes of TCD in these patients.The incidence and the deree of cerebral vasospasm were significantly higher in the severely injured group than the mild injured group (P<0 01).Whether in the severely injured group or mild injured group,the figures from TCD reached to the peak in the days 6～8.The relationship between the varying grades of CT and the cerebral vasospasm has significantly difference (P<0 01).The incidence of CVS from Ⅰgrade to Ⅲ of CT tended upwards,but the incidence of CVS in Ⅳ grade of CT tended downwards.The more severe traumatic subarachnoid hemorrhage in CT findings,the higher incidence of the cerebral vasospasm (P<0 01).The changes of TCD was colsely related to GOS in the days 6～8 and 13～15 after head injury.The longer severe cerebral vasospasm,the poorer outcome;the longer duration of cerebral vasospasm,the poorer prognosis.Conclusions:TCD has many advantages such as nondestructive inspection,convinence,safity,continuity and reapeatability and so on ,we can use it to identify the severity of cerebral vasospasm earlier and to guide the management in the cilinical practice.

关 键 词：经颅超声多普勒 脑血管痉挛 颅脑损伤 计算机X线断层摄影(CT) 

分 类 号：R651.15[医药卫生—外科学] R743.35[医药卫生—临床医学]