TCD监测颅内动脉瘤夹闭术后脑血管痉挛的临床分析  

Transcranial Doppler Monitoring of Cerebral Vasospasm after Intracranial Aneurysm Operation

作　　者：李正伟[1] 李军[2] 冯雨[1] 韩庆东[1] 周平[1] 陈劲草[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科,武汉430030 [2]山东省淄博市中心医院神经外科,淄博255000

出　　处：《华中科技大学学报（医学版）》2011年第1期101-103,共3页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的探讨应用经颅多普勒(transcranial Doppler,TCD)超声诊断颅内动脉瘤夹闭术后脑血管痉挛(CVS)的灵敏度、特异度及影响CVS的相关因素。方法对32例颅内动脉瘤患者行夹闭手术前后应用TCD监测CVS。术前行颅脑CT检查确定蛛网膜下腔出血(SAH)的Fisher分级。采用临床病例分析统计方法,归纳、分析颅内动脉瘤患者术后TCD检查资料。结果以大脑中动脉平均血流速度(VMCA)高于120 cm/s为诊断CVS的标准,术后有17例发生CVS,发生率为53.1%。TCD检测CVS的灵敏度为75%,特异度为78%。Fisher分级Ⅲ、Ⅳ级患者中CVS的发生率有高于Ⅰ、Ⅱ级的趋势。结论 TCD为监测CVS的有效方法;颅内动脉瘤术后CVS的发生可能与Fisher分级的等级有关。TCD可以早期发现颅内动脉的血流速度增高,预测CVS,指导临床医生及时调整治疗方案,避免造成严重并发症。Objective To explore the sensitivity and specificity of transcranial Doppler（TCD）inspection on cerebral vasospasm（CVS）after intracranial aneurysm operation and analyze the relevant factors of CVS.Methods Thirty-two cases of intracranial aneurysm were monitored for vasospasm by TCD before and after operation.The information of TCD was analyzed statistically.Results Regarding VMCA120 cm/s as the diagnostic criteria,CVS occurred in 17 cases（53.1%）.The sensitivity and specificity of TCD were 75% and 78% respectively.The incidence of Fisher scale Ⅲ and Ⅳ was higher than that of scale Ⅰ and Ⅱ.Conclusion TCD is an effective method to inspect CVS.CVS is possibly related to the grade of Fisher score.TCD can find the increases of velocity in the cerebral arteries before symptomatic vasospasm,and helpful to the treatment of the postoperative course of intracranial aneurysms to avoid serious complications.

关 键 词：颅内动脉瘤 超声检查 经颅多普勒 脑血管痉挛 

分 类 号：R445.14[医药卫生—影像医学与核医学]