经颅多普勒对脑动脉瘤手术前后和血管痉挛的血流动力学监测  

Pre-and Postoperative Transcranial Doppler Cerebral Hemodynamic Mornitoring in Patient with Intracranial Aneurysm

作　　者：华杨[1] 凌晨[1] 段安安[1] 丁育基[1] 赵瑞林[1] 陈革[1] 柳江[1] 

机构地区：[1]首都医科大学宣武医院超声科,首都医科大学宣武医院神经外科

出　　处：《中国超声医学杂志》1996年第2期30-33,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：本文应用经颅多普勒（ＴＣＤ）对３６例脑动脉瘤患者术前、术后常规双侧半球及颈内动脉颅外段血流进行监测３～４周。对术后患者随机分组，Ａ组：单纯口服尼莫地平９０～１８０ｍｇ／天；Ｂ组：静脉持续滴注尼莫通２．０～２．５ｍｌ／ｈ，１～２周。Ｃ组：静脉持续滴注尼莫通２．５－３．０ｍｌ／ｈ，１－２周。Ｂ和Ｃ组在静脉用药２周后，继续口服用药９０～１８０ｍｇ／天。检测术前术后血流速度（Ｖｐ，Ｖｄ，Ｖｍ）、收缩期上升支与下降支的时间、舒张期前切迹、血管搏动指数、频谱形态的变化、以及血管痉挛的时间过程。结果表明，利用钙离子通道阻断剂可以有效地抑制血管平滑肌的收缩，对防治缺血性脑损害有重要的临床意义。通过ＴＣＤ无创性可复性监测技术，为临床治疗效果的动态观察和评定提供有价值的客观依据。Thirty-six patients suffered from ruptured berry aneurysm located at anterior part of circle of Willis resulted in pre-and postoperative vasospasm were monitored by TCD. To prevent the damage of brain from symptomatic vasospasm, all patients were given calcium channel blocker- NIMOTOP (Bayer co.). Patients were divided into Group A: 90-180mg/day NIMOTOP orally administered for four weeks, Group B and C: 2. 0-2. 5ml/hour and 2. 5-3. 0ml/hour intravenously administered for two weeks, then oral 90-180mg daily for another two weeks. In comparing the duration of vasospasm and recovery of neurological function and hemodynamic changes,such as the peak, diastolic, mean velocity (Vp Vd Vm), pulsitility index (PI), peak time (PT),decreased time (DT) of cerebral blood flow,the authors found that 70%of patients suffered from SAH showed marked vasospasm occured within 4 to 10 days, while 87. 5%of patients showed marked vasospasm within postoperative 24hours. The vasospasm was completely relased within a short period and good recovery In group C, moderately in group B and slightly in group A, which showed the long duration of vasospasm (P value<0. 001).It is concluded that TCD is a simple, safe and effective non-invasive way in monitoring the onset of vasospasm and pre-and postoperative hemodynamic parameters. NIMOTOP in 2. 5-3. 0ml/hour is more available for maximally controlling the pre-and postoperative vasospasm in cure of such a disease.

关 键 词：脑动脉瘤 围手术期 脑血管痉挛 脑超声波检查 

分 类 号：R739.410.4[医药卫生—肿瘤] R730.41[医药卫生—临床医学]