经颅多普勒超声在重型颅脑创伤去骨瓣减压术后的临床应用  

The clinical application of transcranial doppler ultrasonography in severe traumatic brain injury post decompressive craniectomy

作　　者：常涛[1] 高立[1] 郑龙龙[1] 杨彦龙[1] 李敏[1] 李立宏[1] 

机构地区：[1]第四军医大学唐都医院神经外科,西安710038

出　　处：《中华神经外科杂志》2017年第7期687-690,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨经颅多普勒超声（TCD）在重型颅脑创伤患者去骨瓣减压术后的临床应用。方法回顾性纳入第四军医大学唐都医院神经外科重症监护中心2015年1月至2016年10月收治的58例重型颅脑创伤患者的临床资料，所有患者均行开颅血肿清除术＋去骨瓣减压术＋颅内压（ICP）探头置入术，术后1周采用TCD连续监测脑血流动力学指标，包括时间平均流速（Vmean）、舒张期血流速度（Vedv）和搏动指数（PI），进而评估脑血流状态。结果术后1周Vmean和Vedv的变化趋势呈“U”形，术后第3天最低，分别为（72．5±22．6）cm／s和（43．6±19．8）cm／s，与术后第1、2、6、7天的数值比较，差异均有统计学意义（均P〈0．05）；术后1周PI、ICP的数值连线均呈“抛物线”形，术后第4天最高，PI为1．5±0．7，ICP为（17．2±4．5）mmHg，ICP与术后第1、2、3、6、7天的数值比较，差异均有统计学意义（均P〈0．05）。术后1周脑充血的发生率整体呈下降趋势，术后第1天发生率最高（13．8％，8／58），差异有统计学意义（P〈0．05）；脑缺血在术后第4天发生率最高（36．2％，21／58），差异无统计学意义（P〉0．05）；而脑血管痉挛发生率呈增加趋势，术后第6天发生率最高（15．5％，9／58），差异有统计学意义（P〈0．05）。结论TCD作为一种无创、简单、易操作的监测工具，可有效评估重型颅脑创伤患者术后的脑血流状态。Objective To explore the clinical application of transcranial doppler uhrasonography （TCD） in severe traumatic brain injury （sTBI）post decompressive craniectomy. Methods A retrospective study was conducted on 58 patients with sTBI who were admitted to Neurosurgical Intensive Care Unit of Tangdu Hospital, the Fourth Military Medical University From January 2015 to October 2016. All patients underwent hematoma evacuation, decompressive cranieetomy and placement of intraeerebral pressure （ICP） probe. The parameters of cerebral blood flow including mean velocity （Vmean）, end of diastolic （Vedv） and pulsatility index （PI） in sTBI patients were measured by TCD post operation to assess the cerebral blood supply. Results The trend of Vmean and Vedv manifested U-shaped mode during the next 7 days, reaching the lowest levels [ （72.5 ± 22.6） cm/s and （43.6±19.8 ） cm/s, respectively ; on day 3. There was significant difference in the value of Vmean between day 3 and day 1,2, 5,6, 7 （ all P 〈 O. 05 ）. There was significant difference in the value of Vedv between day 3 and day 1, 2, 6, 7 （ all P 〈 O. 05 ）. The trend of pulsatility index （PI） and intracranial pressure （ICP） showed parabolic shape during the next 7 days, reaching the highest level [ （ 1.5 ± 0.7 ） and （ 17.2 ± 4.5 ） mmHg, respectively ] on day 4. Significant difference was observed in ICP between day 4 and day 1, 2, 3, 6, 7 （P 〈 0.05）. The incidence of cerebral hyperemia showed the trend of declining during the next 7 days. There was significant difference in cerebral hyperemia between day 1 and day 5, 6, 7 （ all P 〈 O. 05）. The incidence of cerebral ischemia was up to 36.2% （12/58） on day 4, and it was significantly higher than that on day 1 （P 〈 0. 05 ）. The incidence of cerebral vasospasm showed the rising trend and reached the highest level （ 15.5% ） on day 6, which had significant difference compared with the incidences on day 1, 2 and 3 （ all P 〈 0. 05 ）. Conclus

关 键 词：颅脑损伤 超声检查 多普勒 经颅 减压颅骨切除术 

分 类 号：R651.15[医药卫生—外科学]