重型颅脑创伤脑死亡脑血流动力学变化的临床分析  

Application and clinical analysis of change cerebral hemodynamics in brain death on account of severe craniocerebral trauma

作　　者：付友增[1] 黄国栋[1] 邓志刚[1] 李维平[1] 王建中[1] 伍健明[1] 高永中[1] 

机构地区：[1]深圳市第二人民医院神经外科,广东深圳518035

出　　处：《中国现代医学杂志》2005年第15期2370-2372,2382,共4页China Journal of Modern Medicine

摘　　要：目的探讨TCD脑血流动力学检测诊断脑死亡和评估昏迷患者预后的临床价值。方法应用TCD动态检测62例GCS≤8分的颅脑创伤患者的大脑前、中、后动脉血流动力学有关参数,以双侧大脑中动脉(MCA)的血流参数和频谱形态为主要观察指标,同时结合临床病情和(CT、ICP)对照研究。结果深昏迷患者大脑中动脉平均血流速度(MCA-Vm)<10cm/s,两条以上的血管出现完全舒张期反向血流或钉子状频谱,血流方向指数(DFI)<0.8,是提示脑死亡的可靠指标。颅内压(ICP)60mmHg是脑功能不可逆转的临界压力指标。PI>2提示预后恶劣,脑血流特征性改变的出现早于临床脑死亡6￣40h。结论脑血流动力学检测对于早期诊断脑死亡和评估深昏迷患者的预后具有较高的临床实用的价值。[Objective] To investigate clinical value of transcranial Doppler（TCD） cerebral hemodynamics in the determination of brain death in patients with severe craniocerebral trauma. [Mothods] The condition of cerebral blood flow were detected using TCD in 62 craniocerebral trauma patients with Glasgow Scores〈8. The waveforms and the cerebral blood flow velocities in the bilateral cerebral arteries （MCA） were considered as the chief observation index, meanwhile the corresponding index of anterior cerebral artery （ACA）, posterior cerebral artery（PCA） and vertebra-basal artery considered as ancillary data. [Results] The mean glow velocity was lower than 10ends in bilateral MCA, and the persistence of full retrograde diastolic flow or small systolic forward flow in above two cerebral vessels, and Direction of flow index （DFI）〈0.8 in MCA in severely comatose patients, was a reliable indicator for confirming brain death. Intracranial pressure （ICP） above 60 mmHg in severely comatose patients was the critical pressure index of inreversible brain damage in severe injury head patients. It is awfully index for prognosis that PI exceed 2. Characteristic change of cerebral hemodynamics take place in 6-40 h before clinical brain death. [Conclusion] Cerebral hemodynamics monitoring is a technique with higher value of clinic utility for predicting and confirming of brain death in patients with severe craniocerebral trauma.

关 键 词：重型颅脑创伤 脑死亡 脑血流动力学 颅内压 

分 类 号：R651.15[医药卫生—外科学]