中、重型颅脑损伤患者脑血流动力学变化与颅内压、脑灌注压的相关性研究  

Study on the correlation of the changes of cerebral hemodynamics with intracranial pressure and cerebral perfusion pressure in patients with moderate and severe craniocerebral trauma

作　　者：黄国栋[1] 李维平[1] 付友增[1] 王建中[1] 伍建明[1] 高永中[1] 

机构地区：[1]广东省深圳市第二人民医院神经外科,518035

出　　处：《中华神经医学杂志》2005年第9期878-882,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨经颅多普勒(TCD)无创检测中、重型颅脑损伤患者的脑血流动力学变化与颅内压和脑灌注压的关系。方法前瞻性研究52例急性中、重型颅脑损伤患者的双侧大脑中动脉血流动力学状态,TCD检测脑血流动力学参数包括收缩期血流速度(Vp)、舒张期血流速度(Vd)、平均血流速度(Vm)、搏动指数(PI)、阻力指数(RI),持续监测颅内压(ICP)和脑灌注压(CPP)、平均动脉血压(MABP)。对脑血流动力学参数、MABP与ICP、CPP进行相关性分析。结果PI、RI与ICP正相关系数分别为PI:r=0.881(P<0.0001);RI:r=0.789(P<0.0001),ICP和CPP与PI、RI、Vd、Vm、MABP多元逐步回归分析发现PI与ICP,CPP与PI、MABP关系最为密切(P<0.0001)。结论无创脑血流动力学检测可实时反映ICP和CPP的变化,可作为ICP和CPP监测的一种有效方法,具有无创、安全、价廉的特点,易于临床推广应用。Objective To explore the relationship of the changes of cerebral hemodynamics with intracranial pressure （ICP） and cerebral perfusion pressure （CPP） in patients with moderate and severe head injuries. Methods A prospective study of 52 patients with moderate and severe head injuries was done in their hemodynamics parameters of bilateral middle cerebral arteries monitored by transcranial Doppler （TCD）, including peak systolic velocity （Vp）, diastolic velocity（Vd）, Mean velocity （Vm）, pulsatility index （PI）and resistent index（RI）. All patients were also detected in ICP, CPP, and mean arterial blood pressure （MABP）. The correlation of the hemodynamics parameters and MABP, ICP CPP （CPP=MABP-ICP）was analyzed. Results There were positive correlations between PI, RI and ICP （PI： r=0.881, P〈0.0001; RI： r=0.789, P〈0.0001）, inverse correlations between PI, RI and CPP （PI： r=-0.559, P〈0.01; RI： r=-0.508, P〈0.01）, high positive correlations between non-invasive CPP （nCPP）, non-invasive ICP （nlCP） and invasive gold standard （CPP, ICP） （nCPP： r=0.815, P〈0.0001; nlCP： r=0.831, P〈0.0001）. By multivariant stepwise regression analysis, ICP, CPP and PI, RI, Vd, Vm were indicated the most close correlation; the regression equations between ICP and PI, RI： ICP=-8.593＋24.295PI（t=13.216, P〈0.0001）, ICP=-47.948＋109.208RI （t=9.098, P〈0.0001）; the equations between CPP and PI, MABP： CPP = 15.596-22.8-86PI ＋ 0.910 MABP （F=76.597, P〈0.0001）. Conclusion The non-invasive cerebral hemodynamics may actually and timely reflect the changes of ICP and CPP in patients with moderate and severe head injuries, so this is an effective means for monitoring ICP and CPP with advantages of non-invasiveness, safety, less cost and convenience.

关 键 词：颅脑损伤 脑血流动力学 颅内压 脑灌注压 

分 类 号：R651.15[医药卫生—外科学]