经颅多普勒超声对颅底肿瘤术后迟发性脑血管痉挛的检测及防治  

The detection and prevention of transcranial Doppler ultrasound in the delayed cerebral vasospasm for skull base tumors postoperative

作　　者：于莹[1] 许海洋[1] 李蕴潜[1] 赵刚[1] 

机构地区：[1]吉林大学白求恩第一医院神经肿瘤外科,吉林长春130021

出　　处：《中风与神经疾病杂志》2015年第3期236-238,共3页Journal of Apoplexy and Nervous Diseases

基　　金：吉林省科技厅资助No.201101043

摘　　要：目的探寻颅底肿瘤术后血管痉挛（CVS）的检测方法及其防治。方法选取自2011年1月-2012年1月我科收治的颅底肿瘤患者74例,根据患者是否应用尼莫地平将患者分为治疗组（40例）和对照组（34例）。经颅多普勒超声（TCD）分析仪,分别于开颅手术前1d和术后1 d、3 d、5 d、7 d、14 d动态监测患侧大脑中动脉（MCA）血流速度,同时与下颌角稍下方测得颈内动脉颅外段（e ICA）血流速度。结果两组共24例患者发生CVS,经TCD检查显示大脑中动脉的平均血流速度≥120 cm/s,其中11例血流速度≥200cm/s。治疗组患者发生CVS 9例占22.5%;对照组患者发生CVS 15例占44.1%。经统计学检验差异有统计学意义（P〈0.05）结论本研究显示应用尼莫地平术中灌洗术后静滴＋口服对于防治颅底肿瘤术后迟发性CVS有效。TCD可以及时、准确、无创的对颅底肿瘤术后迟发性CVS进行动态、量化观察,有利于早期发现CVS的发生及严重程度,可以作为指导治疗的一个指标。Objective To seek for inspection method of vasospasm for skull base tumors postoperative and its prevention and treatment. Methods 74 cases of skull base tumors from January 2011 to January 2012 admitted to our department were divided into treatment group（ 40 cases） and control group（ 34 cases）,according to whether nimodipine managed. TCD analyzer dynamic monitored the ipsilateral middle cerebral artery（ MCA） blood flow velocity respectively on the preoperative day,the first day,the third day,the fifth day,the seventh day,and the fourteenth day postoperative,and measured extracranial internal carotid artery blood flow velocity slightly below the mandibular angle. Results There were 24 cases with vasospasm in two groups,transcranial Doppler ultrasound showed the average flow velocity in the middle cerebral artery ≥120 cm / s,of which 11 cases of blood flow velocity ≥200 cm / s. 9 cases occurred vasospasm in treatment group which accounted for 22. 5%; 15 cases occurred vasospasm in control group which accounted for 44. 1%. The difference of cerebral vasospasm number was statistically significant between the two groups（ P〈0. 05） Conclusion Our study shows that nimodipine can equally effective in prevent ing and treating the delayed cerebral vasospasm for skull base tumors postoperative by intraoperative lavage,intravenous and oral managed. An indicator of transcranial Doppler ultrasound can timely,accurate,non-invasive dynamic quantitative monitor the delayed cerebral vasospasm after skull base tumor operation,is conducive to early detection of vasospasm and severity,can be treated as a guide.

关 键 词：血管痉挛 颅底肿瘤 术后 经颅多普勒超声 

分 类 号：R739.41[医药卫生—肿瘤] R743[医药卫生—临床医学]