经颅多普勒和闪光视觉诱发电位对脑出血微创术的疗效评价  

Clinical evaluation of micro -resecting surgery and intracranial pressure prediction with for patients cerebral hemorrhage by transcranial Doppler and flash visual evoked potential

作　　者：黄永军[1] 安红伟[1] 

机构地区：[1]柳州市中医院神经内科,广西柳州545001

出　　处：《中国急救医学》2013年第6期531-535,共5页Chinese Journal of Critical Care Medicine

基　　金：广西壮族自治区卫生厅科研基金资助项目（Z2009259）

摘　　要：目的探讨经颅多普勒（TCD）与闪光视觉诱发电位（FVEP）对脑出血微创术疗效的评估价值。方法选择发病24h内入院的40例高血压性基底节区大量脑出血患者（25—65mL），按照治疗方法的不同分为：微创手术组和内科保守组，在病程第1天及第7天均行TCD与FvEP检查，记录TCD血流动力学参数、FVEP各波潜伏期、美国国立卫生院神经功能缺损评分（NIHSS）及GCS评分，并用TCD和FVEP两种无创方法对颅内压进行预测。结果两组患者入院时年龄、性别、出血量、破入脑室及中线移位差异无统计学意义；与保守组比较，微创组第1天TCD参数、FVEP各波潜伏期、NIHSS及GCS评分、预测颅内压均无显著变化；微创组第7天脑血流速度显著增快，搏动指数显著降低，FVEP各波潜伏期均显著缩短，预测颅内压显著降低。与第1天比较，第7天微创组脑血流速度显著增快，搏动指数显著降低，FVEP的N2、P3波潜伏期显著缩短，NIHSS及GCS评分无显著变化，预测颅内压显著降低；保守组舒张期血流速度显著减慢，FvEP的N2、P3波潜伏期均显著延长，NIHSS评分、GCS评分及预测颅内压均无显著变化。结论脑出血微创术可显著降低颅内压，改善急性期神经功能，TCD及FVEP对其疗效有肯定的评估价值。Objective Explore assessed evaluation value of minimally invasive hematoma aspiration in efficacy in patients with cerebral hemorrhage, and compared to predict the accuracy of the intracranial pressure （ICP） by transcranial Doppler （TCD） and flash visual evoked potential （FVEP）. Methods Forty cases patients of large volume of hemorrhage （25 - 65 mL） of basal ganglion with hypertensive, who incidence of hospital admission within 24 hours, were divided into conservative treatment group and micro -resecting group. TCD and FVEP checks were performed in the first day and the seventh day of illness, and then performed lumbar puncture, hemodynamic parameters of TCD, latencies of FVEP and cerebrospinal fluid pressure were recorded and analyzed. Results The basic information, such as age, gender, amount of bleeding, whether ruptured into the ventricle and midline shift, the NIHSS and GCS score in the two groups on admission had no significant difference. Compared with the control group, there was no significant difference between hemodynamic parameters of TCD, latencies of FVEP at the first day of illness. The cerebral blood flow of TCD increased and pulsatility index （PI） decreased. Each wave latency of FVEP had no change. NIHSS score decreased, GCS score increased in micro - resecting group. Compared with the first day, the cerebral blood flow of TCD increased and PI decreased, each wave latency of FVEP had no change, NIHSS score decreased, GCS score increased in micro -resecting group in the seventh day. The cerebral diastolic period of TCD decreased and PI increased, FVEP significant prolongation, NIHSS and GCS score had no change in conservative treatment group. Prediction accuracy of ICP in TCD and FVEP was 0. 772, 0. 696 （ P = 0. 000）, error range of ICP was within 5 mm Hg. Prediction accuracy of TCD and FVEP were 75% （45/60） and 67.7% （40/60）. TCD was better than FVEP in ICP prediction, while there was no significant difference. Conclusion Both TCD and FVEP are non - invasive method

关 键 词：脑出血 微创 颅内压(ICP) 经颅多普勒(TCD) 视觉诱发电位(FVEP) 

分 类 号：R774.6[医药卫生—眼科]