脑出血急性期TCD、fVEP的临床动态观察与相关性研究  

A Clinical Dynamic Observation and Correlative Study of TCD and fVEP in Acute ICH

作　　者：杜鑫[1] 朱榆红[1] 高平[1] 赵涛[1] 李燕[1] 

机构地区：[1]昆明医学院第二附属医院神经内科,昆明650101

出　　处：《昆明医学院学报》2006年第2期87-91,共5页Journal of Kunming Medical College

摘　　要：目的探讨脑出血急性期经颅多普勒超声(TCD)的动态变化规律以及与颅内压、病情、预后之间的相关性.方法对54例首次发病且发病24 h内入院的幕上自发性脑出血患者,于入院第1、7、21天进行床旁TCD检测,并与fVEP、MESSS进行对比研究及相关性分析.结果脑出血急性期TCD异常以大脑前循环为主,主要表现为高阻力低流速的血流频谱,出血侧更明显,两侧血流明显不对称.连续TCD监测发现,降低的血流速度逐渐增高,同时增高的脉动指数(PI)则逐渐降低,至发病3周后TCD检测基本恢复至正常范围.无创颅内压监护仪所得颅内压值与大脑中动脉Vm呈负相关,与PI值呈正相关.MESSS评分与大脑中动脉Vm呈负相关,与PI值呈正相关.结论TCD检查可用于脑出血患者急性期脑血流动力学的监测和病情判断.fVEP法无创颅内压监护与TCD两者结合使用有助于判断颅内压的动态变化并指导降颅压治疗.Objective To investigate the cerebral regularity of dynamic charge and the correlation with intracranial pressure （ICP）, clinical seriousness and prognosis on acute stage of intracerebral hemorrhage （ICH） patients by transcranial Doppler （TCD）. Methods 54 patients with first acute supratentorial ICH 24h after onset were studied. All patients were dynamic evaluated by beside TCD on 1st, 7th, 21st day. The correlation of TCD with ICP , MESSS were studied. Results On the 1 st day the TCD abnormity of the acute phase of the ICH occurred mainly in the anterior circulation of cerebrum, in which the cardinal manifestation was high - resistance, low -flow velocity blood waveforms, especially on the bleeding side. Continuous TCD monitoring revealed the low velocity of the cerebral blood flow increased ; meanwhile the high value of PI decreased gradually and the TCD monitoring was within the normal range three weeks after the attack. The ICP had negative correlation with the VmMCA, positive correlation with the PI value. MESSS scale had negative correlation with the VmMCA, positive correlation with the PI value. Conclusions The TCD examination can be used to monitor the cerebral hemodynamics of the patients suffering from intracerebral hemorrhage. The combination of fVEP and TCD facilitate the evaluation of the dynamic changes of ICP so as to instruct lowering the ICP.

关 键 词：脑出血 经颅多普勒 闪光视觉诱发电位 

分 类 号：R743.34[医药卫生—神经病学与精神病学]