动脉瘤性蛛网膜下腔出血后脑血管痉挛的脑血流动力学改变  

Cerebrovascular hemodynamic changes of cerebral vasospasm after aneurysmal subarachnoid hemorrhage

作　　者：惠品晶[1] 刘曼[1] 王中[2] 孔丽娟[1] 李向东[2] 周幽心[2] 虞正权[2] 崔岗[2] 张世明[2] 周岱[2] 

机构地区：[1]苏州大学附属第一医院神经外科脑血管超声室,215006 [2]苏州大学附属第一医院神经外科,215006

出　　处：《中华脑血管病杂志（电子版）》2011年第6期6-10,共5页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：江苏省医学重点学科资助项目(XK200722);苏州大学附属第一医院基金资助(YT0701)

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血(aSAH)后脑血管痉挛(CVS)的血流动力学改变。方法对337例(382枚动脉瘤)aSAH患者临床资料进行回顾性分析,均经数字减影血管造影(DSA)和/或CT血管造影(CTA)检查证实为动脉瘤(An),其中动脉瘤颈夹闭术297例,瘤颈夹闭及载瘤动脉塑形术29例,动脉瘤孤立术8例及包裹术3例。术后给予尼莫地平持续泵入扩血管、脑脊液引流、3H疗法等治疗,并于SAH1～3d、4～7d、8～14d、15～20d进行床边经颅超声多普勒(TCD)检测,主要观察MCA平均血流速度(VmMCA)、计算Lindegaard指数,即同侧MCA与颅外段ICAVm之比(LI),观察CVS及颅内压(ICP)等脑血流动力学变化。结果 SAH患者不同程度的存在CVS,25%的患者1～3d就出现CVS,8～14d达高峰;Hunt-Hess分级与CVS的变化成正相关;102例患者(102/337,30.3%)出现不同程度的颅内压增高;17例(17/337,5%)出现延迟性缺血性神经功能障碍(DIND),颅内压增高且有CVS者预后较差。结论 TCD可以床边、动态监测aSAH患者的脑血流动力学改变,具有无创、简单易行的特点。TCD检测的脑血流速度、Lindegaard指数和频谱形态相结合对临床和血管造影诊断CVS有价值。Objective To investigate the cerebrovascular hemodynamic changes of cerebral vasospasm after aneurysmal subarachnoid hemorrhage （SAH）. Methods The clinical records and radiographic images of 337 patients （382 intracranial aneurysms） with aneurysmal subarachnoid hemorrhage were retrospectively reviewed. 337 patients in whom aneurysmal SAH was demonstrated by computed tomography, and in whom one or more intracranial aneurysms had been diagnosed by angiography,underwent transcranial Doppler （TCD） studied. 297 of them were treated by surgical occlusion using aneurysm clips,29 cases were treated by surgical occlusion using aneurysm clips and parent artery was reshaped, 8 cases were treated by surgical isolated aneurysm and 3 cases were treated by surgical parcel. After the operation, patients were treated with Nimodipine, cerebrospinal fluid drainage and 3 H therapy. Blood flow parameters and plateau waves of Willis artery were recorded and analyzed with bedside TCD at 1-3 d,4-7 d,8-14 d, 15-20 d after SAH,Especially mean peak flow velocity and Lindegaard index of the middle cerebral artery （MCA）. To observe the hemodynamic changes of cerebral vasospasm （CVS） and intracranial pressure （ICP）. Results There are cerebral vasospasm with different degrees in aneurysmal subarachnoid hemorrhage. 25% of patients appeared CVS in SAH 1-3d, CVS peak in SAH 8-14d. Hunt-Hess grade and positively related to changes in CVS. 102 patients （ 102/337,30.3% ） appeared increased intracranial pressure with varying degrees. 17 cases （17/337,5%） appeared delayed ischemic neurological dysfunction （DIND）. However, there would be higher mortality and neurological deficits when intracranial hypertension and cerebral vasospasm. Conclusions TCD could detect the dynamic hemodynamic changes with aneurismal SAH in an innovative, flexible, accessible tool for the bedside monitoring. The use of TCD velocities, Lindegaard ratio, and plateau waves combination is of useful value for the diagnosis of clinical and angiogr

关 键 词：经颅超声多普勒 颅内动脉瘤 蛛网膜下腔出血 脑血管痉挛 颅内压 血流动力学 

分 类 号：R743.3[医药卫生—神经病学与精神病学]