急性脑水肿重症患儿经颅多普勒超声监测的临床研究  

The clinical study of TCD monitoring for children with acute cerebral edema

作　　者：杨思达[1] 宁书尧[1] 王秀英[1] 戴津[1] 司徒敏雄[1] 杨丽[1] 麦坚凝[1] 

机构地区：[1]广州市儿童医院,广东广州510120

出　　处：《中国实用儿科杂志》2008年第1期53-56,共4页Chinese Journal of Practical Pediatrics

基　　金：广东省卫生厅科研项目资助(项目编号:A2005571)

摘　　要：目的观察急性脑水肿患儿经颅多普勒(TCD)各项检测参数及频谱的变化,探讨TCD在监测与评估急性脑水肿患儿颅内压的作用。方法对广州市儿童医院2004年6月至2007年4月收治的73例符合急性脑水肿诊断的危重症患儿应用TCD进行床边监测,分析各年龄段急性脑水肿患儿以及小儿昏迷量表评分不同分值下TCD的各项参数(Vs、Vd、Vm、PI、RI)和血流频谱特征并与同龄段的正常对照组进行比较。结果急性脑水肿患儿的TCD显示,Vd及Vm下降,PI、RI升高,与对照组相比有着显著性差异(P<0.01),Vs与对照组相比无显著性差异(P>0.05)。同时其血流频谱在颅内压升高的不同阶段呈现出不同的特征性改变:即急性脑水肿ICP增高初期,血流频谱表现为收缩峰变尖锐,而平均血流速度无明显改变。部分病例表现为收缩期与舒张期血流速度均升高,频窗紊乱,Lindegaard指数(VmMCA/VmICA)>3,提示脑血管痉挛;随病情发展,脑血流速度进一步下降,频谱表现为收缩峰尖锐高阻波形。当脑血管阻力进一步增加,TCD监测频谱表现为高尖的收缩期正相血流,舒张期逆向负相血流的"振荡波",当颅内压接近舒张压时,舒张期血流消失,频谱表现为"钉子波",病情进展最终血流信号减弱直至消失。结论TCD可直接提示脑血流灌注的状态,反映脑水肿患儿颅内压力的变化,以及脑血流自动调节功能是否尚存,对于病情判断以及颅内压增高的早期干预均有重要的临床指导意义。当TCD频谱表现为收缩期血流正相而舒张期血流负相的振荡波、收缩期血流钉子波或无血流信号,患儿预后极差。Objective To monitor the children with acute brain edema by transcarnial doppler （TCD） ,and to investigate the relationship between intracranial pressure and parameters of TCD. Methods To classify 73 patients who diagnosed with Acute Brain Edema into 4 groups by Glasgow Coma Scale,and then examined them by TCD. To observe the parameters （Vs,Vd,Vm,PI,RI） and the flow patterns,and to compare them with that of the normal children. Results In the patients group,the value of Vd and Vm were decreased and the value of PI and RI were increased,which were significantly different from those of the normal children （ P 〈0. 01 ）. The Vs showed no difference between the two groups （ P 〉 0. 05 ）. And the characteristic flow patterns appeared in the patients group. In the early stage the patients flow patterns show that the systolic peak is sharpened,while the mean blood velocity change little. However some show that the Vs and Vd is raised obviously, and Lindegaard index 〉 3, which means convulsion occurred. In the further stage, the cerebral blood velocity decreases apparently, and the patterns show that the systolic peak is sharpened obviously either. With the increase of the intracranial pressure, the Doppler sonograms show three characteristic flow patterns in the following sequence： retrograde diastolic flow,small systolic triangular flow,and no detectable flow signals. Conclusion Based on the parameters of homodynamic obtained by TCD, patients could be classed approximately with the level of the intraeranial pressure, and the treatment can be estimated as well. It always means poor prognosis when the characteristic flow patterns （retrograde diastolic flow, small systolic triangular flow, and no detectable flow signals）appear.

关 键 词：经颅多普勒超声 急性脑水肿 颅内压 儿童 脑血流动力学 昏迷量表评分 

分 类 号：R72[医药卫生—儿科]