脑出血患者经颅多普勒超声评估颅内压变化研究  

Study on Intracranial Pressure Changes with Transcranial Doppler Ultrasound in Patients with Intracerebral Haemorrhage

作　　者：吴建维[1] 贾娇坤[1] 丁则昱[1] 赵性泉[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经病学中心,国家神经系统疾病临床医学研究中心,脑血管病转化医学北京市重点实验室,北京100050

出　　处：《中国卒中杂志》2016年第10期836-841,共6页Chinese Journal of Stroke

摘　　要：目的为进一步验证脑出血患者颅内压(intracranial pressure,ICP)与经颅多普勒超声(transcranial Doppler ultrasound,TCD)血流参数间的相关性,确立脑出血患者TCD血流参数预测ICP的最优数学模型并评价其预测准确性。方法根据纳入、排除标准,共登记22例脑出血患者的人口学资料、主要神经功能评分和病灶特征资料,所有患者行持续床旁脑实质颅内压监测,期间每天复查TCD,监测大脑中动脉(middle cerebral artery,MCA)及颈内动脉(internal carotid artery,ICA)血流参数并记录即时ICP数值、体温、血压、心率和血氧饱和度等。筛选最优TCD血流参数,对即时ICP与TCD血流参数行相关性分析及多元线性回归分析,建立TCD参数评估ICP数学模型,并对其诊断颅高压(ICP>15 mm Hg)的准确性进行评价。结果相关性分析示脉搏指数(pulsatility index,PI)与ICP呈正相关,相关系数为r=0.66(P<0.01)。TCD血流参数预测ICP数学模型为ICPe=-16.8+26.8×PI+0.12×Vm,调整R2为0.46;颅高压(ICP>15 mm Hg)时,ICPe的曲线下面积为0.93,95%可信区间为0.88~0.97。结论 TCD血流参数PI与ICP呈正相关,是预测ICP最重要的指标。ICPe=-16.8+26.8×PI+0.12×Vm(调整R^2为0.46)可准确诊断颅高压(ICP>15 mm Hg)。Objective To further verify the correlation between intracranial pressure（ICP） and blood flow parameters of transcranial Doppler ultrasound（TCD） in patients with cerebral hemorrhage. The optimal mathematical models of intracranial pressure were established, which were predicted quantitatively by blood flow parameters of TCD, and then evaluated the accuracy.Methods According to the inclusion and exclusion criteria, demographic data, major neurological function scores and characteristics of lesions of 22 patients with cerebral hemorrhage were registered. The intracranial pressure monitor was used to monitor the intraparenchymal pressure continuously at the bedside. TCD detection was reviewed daily. The blood flow parameters of MCA and ICA, the instant ICP values, temperature, blood pressure, heart rate, and oxygen saturation were recorded. The analyses of multiple linear regression were completed to establish the optimal mathematical model of ICP evaluated by TCD parameters, and then evaluate the accuracy for the diagnosis of intracranial hypertension（ICP〉15 mmHg）.Results The correlation analysis of PI and ICP showed positive correlation, and the correlation coefficient was r =0.66（P〈 0.01）. The mathematical model was ICPe=-16.8＋26.8×PI＋0.12×Vm, adjusted R^2=0.46; When ICP〉15 mmH g, the area under curve of ICPe was 0.93, and 95% confidence interval was 0.88-0.97.Conclusion PI is positively correlated with ICP, and is the most important predictive indicator of the ICP evaluation. ICPe=-16.8＋26.8×PI＋0.12×Vm（adjusted R^2=0.46） could predict the ICP to diagnose the intracranial hypertension（ICP〉15 mmHg） with high accuracy.

关 键 词：脑出血 颅内压 经颅多普勒超声 搏动指数 

分 类 号：R743.34[医药卫生—神经病学与精神病学]