经颅多普勒结合CT血管造影对重型颅脑损伤手术疗效及预后的判定  

Judgment of operative effect and prognosis of severe craniocerebral trauma by transcranial Doppler combined with CT angiography

作　　者：李敏[1] 王玉海[1] 蔡桑[1] 杨理坤[1] 朱军[1] 王剑超[1] 陈磊[1] 张春雷[1] 蔡学见[1] 

机构地区：[1]江苏大学临床医院,解放军第一0一医院神经外科,全军颅脑损伤救治中心,无锡214044

出　　处：《中华创伤杂志》2012年第3期205-210,共6页Chinese Journal of Trauma

基　　金：南京军区“十一五”重点课题资助项目（082005）

摘　　要：目的研究重型颅脑损伤后血管形态及血流变化，探讨经颅多普勒（transcranial Dopple，TCD）超声结合cT血管造影（CTangiography，CTA）对重型颅脑损伤手术疗效及预后的判定作用。方法对56例重型颅脑损伤患者术前及术后使用TCD动态监测，并使用128层螺旋CT行头颅CTA动态检查。结果重型颅脑损伤后TCD、CTA显示脑血流及血管形态均发生改变。CTA显示以血管移位或狭窄为主者，TCD波谱多呈高阻力型改变，手术疗效良好；血管痉挛者，频谱呈高阻力型（手术疗效相对较好）或“钉子波”（手术疗效多不良）；血管闭塞者TCD多呈“钉子波”，手术疗效差。结论TCD反映脑血流速度，CTA表现脑血管形态改变，二者结合能有效判断脑灌注情况，是重型颅脑损伤手术疗效判定的良好方法。Objective To observe the changes of cerebral vascular morphology and blood flow after craniocerebral trauma so as to investigate the role of transcranial Doppler sonography （TCD） combined with CT angiography （CTA） in judgment of the operative effect and prognosis of severe craniocerebral trauma. Methods A total of 56 patients with craniocerebral trauma were monitored dynamically by using TCD before and after surgery. Dynamic CTA of head was also performed by using 128-slice spiral CT. Results TCD and CTA indicated that both the cerebral blood flow and vascular morphology changed after craniocerebral trauma. CTA manifested mainly the vascular displacement or angiostegnosis and TCD showed mainly the high-resistance blood flow, indicating good operative effect. For the patients with vasospasm, the TCD manifested high-resistance flow （relatively good operative effect） or ＂nail flow＂ （mostly poor operative effect）. The patients with vascular occlusion were associated with nail flow on TCD, with poor operative effect. Conclusions TCD shows the velocity of cerebral blood flow and CTA shows the morphological change of cerebral vessels. Thereby, the combination of TCD and CTA can effectively judge the cerebral perfusion and provide a promising way for validating the operative effect and prog- nosis of craniocerebral trauma.

关 键 词：颅脑损伤 超声检查 多普勒 经颅 预后 

分 类 号：R651.1[医药卫生—外科学]