经颅多普勒在颅脑外伤合并蛛网膜下腔出血中的监测作用  

Application of transcranial doppler in the monitoring of traumatic subarachnoid hemorrhage

作　　者：江志静 李兵[2] 胡世颉[2] 杨炳石 胡学安[2] 曹宝萍[2] 费舟[2] 

机构地区：[1]解放军413医院外二科,浙江舟山316000 [2]第四军医大学西京医院神经外科,陕西西安710032

出　　处：《中华神经外科疾病研究杂志》2014年第5期434-437,共4页Chinese Journal of Neurosurgical Disease Research

基　　金：国家自然科学基金资助项目(81101710)

摘　　要：目的研究经颅多普勒(TCD)在颅脑外伤合并蛛网膜下腔出血(t SAH)中对脑血流量和颅内压(ICP)的监测作用。方法采用TCD监测65例经CT确诊t SAH患者大脑中动脉(MCA)的动脉平均峰值流速(Vm)、搏动指数(PI)、阻力指数(RI)和血流频谱,并比较外伤后3 d,7 d,21 d患侧与自身健侧PI值。结果 PI、RI比Vm更能反映ICP的变化,颅脑外伤后3 d,7 d,21 d患侧与自身健侧PI明显升高,P<0.05;当PI>1.0,RI>0.6时,应考虑ICP升高,同时TCD血流频谱可作为监测ICP的辅助指标。结论采用TCD监测t SAH患者脑血流变化,部分参数与ICP有一定的相关性,可以间接反应ICP的变化,并提高脑血管痉挛的检出率,为临床治疗提供参考依据。Objective The application of transcranial doppler（ TCD） in the brain blood flow and intracranial pressure（ ICP） monitoring of traumatic subarachnoid hemorrhage（ t SAH） is discussed. Methods TCD was applied to detect the mean blood velocity（ Vm）,pulsatility index（ PI）,resistance index（ RI）and blood flow spectrum of the middle cerebral artery（ MCA） in the 65 patients with t SAH diagnosed by CT.And PI of suffered side and healthy side at 3 d,7 d,and 21 d after t SAH was collected to compare the changes of PI. Results PI and RI were a better reflection of ICP compared with Vm. There was statistical significant difference between PI of suffered side and healthy side at 3 d,7 d,21 d after t SAH（ P 0. 05）. PI 1. 0 and RI 0. 6 were an indicator of ICP increase. The parameter of blood flow spectrum should be considered as the second indicator of ICP monitoring. Conclusion The parameters of TCD can reflect the changes of brain blood flow and ICP,which may be helpful for the diagnosis and treatment of t SAH and secondary cerebral vasospasm.

关 键 词：经颅多普勒超声 颅脑损伤 蛛网膜下腔出血 颅内压 脑血管痉挛 

分 类 号：R743[医药卫生—神经病学与精神病学]