创伤性急性弥漫性脑肿胀患者TCD参数与颅内压的相关性研究  

Correlation between parameters of TCD and intracranial pressure in patients with posttraurnatic acute diffuse brain swelling

作　　者：辛志成[1] 吴钟华[1] 龙连圣[1] 王开磊[1] 李夏良[1] 蒋超超[1] 苏强[1] 王伟[1] 

机构地区：[1]中国人民解放军第98医院神经外科,浙江湖州313000

出　　处：《海南医学》2015年第21期3141-3143,共3页Hainan Medical Journal

基　　金：南京军区医学科技创新经费资助项目(编号:10MA006)

摘　　要：目的探讨创伤性急性弥漫性脑肿胀(PADBS)患者经颅多普勒(TCD)参数与颅内压(ICP)的关系。方法选择40例行有创ICP监测的PADBS患者(观察组)以及10例健康志愿者(对照组),采用TCD床旁检测双侧大脑中动脉舒张期末血流速度(Vd)、平均血流速度(Vm)、收缩期峰值血流速度(Vs)以及搏动指数(PI)、阻力指数(RI),并记录即时ICP值。观察组患者按ICP进行分组,将其TCD各参数与对照组进行比较分析。结果随着ICP的升高,Vd、Vm、Vs均呈下降趋势,而PI、RI则呈逐渐升高趋势。其中Vd在ICP轻度升高时即明显下降(P<0.05),而Vs只有在ICP重度升高时才明显下降(P<0.05),PI与ICP的相关系数最大(r=0.874,P<0.01)。结论 TCD可以无创监测PADBS患者ICP的变化,对临床治疗具有重要指导意义。Objective To investigate the correlation between parameters of transcranial Doppler （TCD） sonog-raphy and intracranial pressure in patients with posttraurnatic acute diffuse brain swelling （PADBS）. Methods Forty PADBS patients whose intracranial pressure was monitored （observation group） and 10 healthy subjects （control group） were recruited for this case-control study. Bedside TCD was employed to measure end diastolic velocity （Vd）, mean velocity （Vm）, systolic peak velocity （Vs）, pulsatility index （PI）, and resistance index （RI） of bilateral middle ce-rebral arteries. Meanwhile, real-time recording of intracranial pressure was performed. Patients in the observation group were further divided based on the levels of intracranial pressure, and TCD parameters of those patients were compared with those obtained from the control group. Results When intracranial pressure increased, Vd, Vm, and Vs tended to decrease, whereas PI and RI increased gradually. Notably, Vd significantly decreased when there was a slight increase in intracranial pressure （P〈0.05）. In comparison, a significant decline in Vs can only be observed when intracranial pressure was severely elevated （P〈0.05）. Our results further showed that PI exhibited the stron-gest correlation coefficient with intracranial pressure （r=0.874, P〈0.01） among the TCD parameters that were mea-sured. Conclusion TCD can be used as a noninvasive procedure to monitor intracranial pressure in patients with PADBS. These findings provide important guidelines to manage the patients in the future.

关 键 词：创伤性急性弥漫性脑肿胀 经颅多普勒 颅内压 

分 类 号：R651.15[医药卫生—外科学]