脑出血患者的血压调控以及经颅多普勒监测的临床意义  

Blood Pressure-Regulation in Patients with Intracerebral Hemorrhage and Clinical Significance of Transcranial Doppler Monitoring

作　　者：吴玉平[1] 于洋[1] 王宇[1] 

机构地区：[1]沈阳医学院附属奉天医院神经外科,110024

出　　处：《国际脑血管病杂志》2006年第6期418-421,共4页International Journal of Cerebrovascular Diseases

摘　　要：目的:研究高血压性脑出血患者的血压调整幅度与应用经颅多普勒(TCD)监测脑血流动力学改变的临床指导意义。方法:动态监测64例发病后10h内入院的脑出血患者的血压,其中38例入院24h内行颅内血肿穿刺和置管引流术(手术组),18例患者行保守治疗(保守组),患者于入院当时以及第1、4、7天和2周时进行TCD监测;另外8例未手术者(降压组)在接受抗高血压治疗前、后行TCD监测,并与26例单纯高血压患者(对照组)抗高血压治疗前、后的TCD参数进行比较。结果:对照组抗高血压治疗前、后的TCD参数无显著差异,而降压组降压后双侧大脑中动脉(MCA)流速降低,搏动指数(PI)升高。脑出血患者治疗过程中血压逐渐下降,双侧MCA流速呈先降后升,双侧PI值呈先升后降趋势。保守组的MCA流速在发病1周内下降,第2周开始升高,PI值改变与其相反;手术组第7天MCA流速即升高,PI值降低,且在第14天两组间有显著差异;手术组血压下降幅度较保守组大,第14天时两组间的收缩压有显著差异。结论:颅内血肿穿刺和置管引流术可显著改善脑出血患者的脑灌注程度,而急性期抗高血压治疗不利于脑灌注,动态TCD监测可评价患者脑灌注状态和指导临床治疗。To study the adjustment amplitude of blood pressure in patients with hypertensive intracerebral hemorrhage and the guiding significance in clinical practice in monitoring the changes of cerebral hemodynamics by transcranial Doppler （TCD）. Methods： The blood pressures of sixty-four hospitalized patients with intracerebral hemorrhage were monitored dynamically within 10 hours after the onset. Among them, 38 patients had intracranial hematoma puncture and tube drainage within 24 hours of hospitalization （operation group）, and 18 patients had conservative treatment （conservative group）. Patients were monitored with 3CD at the time of hospitalization on day 1,4, 7, and 14. Another 8 unoperated patients （antihypertensive group） were monitored with TCD before and after antihypertensive treatment, and they were compared with the TCD parameters of 26 simple hypertensive patients （control group） before and after antihypertensive treatment. Results：There was no significant difference in TCD parameters in the control group before and after antihypertensive treatment, however, the blood flow velocity of bilateral middle cerebral arteries （MCA） decreased, and the pulsatility index （P]） increased after antihypertensive treatment in the antihypertensive group. 3-he blood pressure in patients with intracerebral hemorrhage decreased gradually during the treatment, while the blood flow velocity of bilateral MCA decreased first, and then increased. The PI values of bilateral MCA increased first, and then decreased. The blood flow velocity in the conservative group decreased within the first week of the onset. It began to increase at week two and the changes of PI values were contrary to it.The blood flow velocity of MCA increased on day 7 and PI values decreased in the operation group, and there was significant difference between the 2 groups on day 14.The blood pressure decreased more significant in the operation group than that in the conservative group, and there were significant differences in sys

关 键 词：高血压 脑出血 经颅多普勒 手术治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]