经颅多普勒早期预警动脉瘤性蛛网膜下腔出血致延迟性脑缺血  

Clinical study on the application of transcranial Doppler in early warning of delayed cerebral ischemia induced by aneurysmal subarachnoid hemorrhage

作　　者：梅涛[1] 王蕾[1] 徐立新[1] 袁辉纯[1] 文江力 肖为[1] 贾哲勇 邵丽华[1] 阙思伟[1] 

机构地区：[1]常德市第一人民医院神经外科,湖南常德415003

出　　处：《国际神经病学神经外科学杂志》2016年第5期396-398,共3页Journal of International Neurology and Neurosurgery

摘　　要：目的探讨经颅多普勒（transeranial Dopier，TCD）对动脉瘤性蛛网膜下腔出血（aneurysmal subarachnoid hemorrhage，aSAH）致迟发性脑缺血（delayed cerebral ischemia，DCI）的早期预警作用及意义。方法应用经颅多普勒技术前瞻性地对85例aSAH病例进行动态连续监测，经临床证实后分为迟发脑缺血（DCI）组和非迟发脑缺血（NDCI）组，并对两组大脑中动脉平均血流速度（mean cerebral blood flow velocity，MBF，cm／s）、搏动指数（pulsatility index，PI）及预后进行对比分析。结果全组中符合迟发脑缺血（DCI）组诊断30例（35．3％），其中56．7％的病例发生在起病6—8d以内；DCI组MBF较入院首测明显增加（t=23．847，P=0．000），H值增加不明显（t=0．733，P=0．468）。NDCI组MBF、PI值与入院首测无明显改变（t=0．547，P=0．585；t=0．573，P=0．568）；GOS评分DCI组良好率显著低于NDCI组（x^2=11．5145，P=0．001），DCI组中残、植物生存率明显高于NDCI组（x^2=4．1098，P=0．043；P=0．041）。两组重残、死亡率无统计学意义（P=0．339，0．122）。结论经颅多普勒因无创、可连续监测的优点可成为早期预警动脉瘤性蛛网膜下腔出血致延迟性脑缺血的有效手段，并可为临床干预提供指导。Objective To determine the clinical effect and significance of transcrania] Doppler （TCD） in the early warning of delayed cerebral ischemia （DCI） induced by aneurysmal subaraehnoid hemorrhage （aSAH）. Methods Eighty-five aSAH patients, who were dynamically and continuously monitored with TCD, were divided into two groups after clinical diagnosis： DCI group and non-DCI group, which were analyzed and compared in terms of their mean cerebral blood flow velocity （MBF） in the middle cerebral artery （ MCA）, pulsatility index （PI）, and prognosis. Results Thirty patients （35.3 % ） in all the 85 patients were diagnosed with DCI, and 56.7% of these cases occurred within 6 - 8days of onset. After admission, MBF in the DCI group significantly increased from their initial MBF result （ t = 23. 847, P = 0. 000）, but PI in the DCI group （ t = O. 733, P =0. 468 ）, MBF in the non-DCI group （ t = 0. 547, P = 0. 585 ）, and PI in the non-DCI group （ t = 0. 573, P = 0. 568） were not significantly changed. The DCI group had a sig- nificandy lower proportion of patients with good Glasgow Outcome Scale scores than the non-DCI group （x^2 = 11.5145, P = 0. 001 ）. The moderate disability rate and vegetative survival rate in the DCI group were significantly higher than those in non-DCI group （X2 = 4. 1098, P = 0. 043, P = 0. 041 ）. There were no significant differences in mortality rate and severe disability rate between the two groups （P = 0. 122 and 0. 339 ）. Conclusions TCD, due to its advantages of non-invasiveness and continuous monitoring, may become an effective method for the early warning of DCI induced by aSAH, thus providing guidance for clinical intervention.

关 键 词：动脉瘤性蛛网膜下腔出血 迟发性脑缺血 经颅多普勒 早期预警 

分 类 号：R743.3[医药卫生—神经病学与精神病学]