TCD颅内压监测在急性大面积脑梗死颅内压管理中的应用研究  

Application of TCD Intracranial Pressure Monitoring in Intracranial Pressure Management of Acute Large Area Cerebral Infarction

作　　者：周映彤[1] 黎罗明[1] 邹达良 

机构地区：[1]广东省中山市陈星海医院,广东中山528415

出　　处：《中国医学创新》2017年第18期20-23,共4页Medical Innovation of China

基　　金：广东省中山市卫生局项目(2015A020072)

摘　　要：目的:观察和分析TCD颅内压监测在急性大面积脑梗死颅内压管理中的临床意义。方法:选取本院2015年3月-2016年5月的60例急性大面积脑梗死患者作为研究对象,入院24 h内进行TCD监测,并检查血清中神经元特异性烯醇化酶(NSE)的含量。根据颅内压状态将患者分为试验组(高颅内压患者)和对照组(正常颅内压患者),每组30例,两组除常规治疗外,对试验组患者采取降颅内压治疗,评估两组患者的预后效果。结果:试验组的血清NSE含量明显高于对照组,差异有统计学意义(t=6.91,P<0.05)。根据TCD监测结果,试验组中颈内动脉(ICA)、大脑中动脉(MCA)平均血流速度均较对照组减慢,且MCA减慢更为明显,差异均有统计学意义(P<0.01)。试验组患者MCA的Vs、Vm、Vd均低于对照组,差异均有统计学意义(P<0.01),试验组PI、RI水平均高于对照组,差异均有统计学意义(P<0.05)。两组患者治疗后随访6个月,试验组的预后良好率为73.33%,对照组的预后良好率为80.00%,差异无统计学意义(字2=0.37,P>0.05)。结论:急性大面积脑梗死可通过TCD及时了解颅内血流动力及血管阻力改变,及时反映颅内压和脑血流量,为判断病情及确定治疗方案提供参考,减少盲目降颅压治疗,避免过度降颅压的危害,改善患者的预后。Objective：To observe and analyze the clinical significance of TCD intracranial pressure monitoring in management of intracranial pressure in acute large area cerebral infarction.Method：From March 2015 to May 2016,60 cases with acute large area cerebral infarction in our hospital were selected as the research objects,all the cases were examined by TCD within 24 hours after admission to hospital,the patients were divided into experimental group（high intracranial pressure cases） and control group（normal intracranial pressure cases）,30 cases in each group,two groups excepted routine treatment,the experimental group was treated with intracranial pressure reduction treatment,the prognosis of the two groups were evaluated.Result：The serum NSE level in the experimental group was higher than that in the control group,the difference was statistically significant（t=6.91,P〈0.05）.According to the results of TCD,the average blood flow velocity of the internal carotid artery（ICA） and middle cerebral artery（MCA） of the experimental group were slower than those of the control group,and the MCA slowed down more significantly,the differences were statistically significant（P〈0.01）.Compared with the control group,the Vs,Vm and Vd of MCA in the experimental group were significantly decreased,the differences were statistically significant（P〈0.01）,the PI and RI of the experimental group were significantly higher than those of the control group,the differences were statistically significant（P〈0.05）.Both of the two groups were followed up to assess the prognosis for 6 months after the treatment,the good prognosis rate of the experimental group was 73.33%,and the control group was 80.00%,there was no significant difference（Х^2=0.37,P〉0.05）.Conclusion：The changes of intracranial hemodynamic and vascular resistance of acute large area cerebral infarction patients can be checked by TCD timely,the intracranial pressure and cerebral blood flow also can be reflected in time,the result can av

关 键 词：急性大面积脑梗死 经颅多普勒 颅内压监测 

分 类 号：R743.3[医药卫生—神经病学与精神病学]