经颅多普勒预测高改良Fisher分级蛛网膜下腔出血后迟发性脑缺血研究  

Study on Transcranial Doppler in Predicting Delayed Cerebral Ischemia after Subarachnoid Hemorrhage with Higher Modified Fisher Grade

作　　者：吴建维[1] 郭军平[1] 贾娇坤[1] 丁则昱[1] 杨中华[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》2017年第9期781-785,共5页Chinese Journal of Stroke

摘　　要：目的观察在高改良Fisher分级的蛛网膜下腔出血患者中双侧大脑中动脉血流速度比值(mean blood flow velocity ratio of the ipsilateral to contralateral middle cerebral arteries,I/C m BFV)对于迟发性脑缺血(delayed cerebral ischemia,DCI)的预测价值是否高于大脑中动脉平均血流速度(mean blood flow velocity,m BFV)≥120 cm/s。方法回顾性连续收集2011年11月-2013年11月首都医科大学附属北京天坛医院NICU住院的改良Fisher分级≥3级的蛛网膜下腔出血患者,所有患者均接受经颅多普勒(transcranial doppler sonography,TCD)检查。记录大脑中动脉m BFV及双侧I/C m BFV。终点事件为DCI。计算I/C m BFV和大脑中动脉m BFV≥120 cm/s预测DCI的敏感性、特异性、阳性预测值及阴性预测值。结果共44例患者纳入研究,共18例患者发生了迟发性脑缺血,发生率为41%。以大脑中动脉m BFV≥120 cm/s为标准时,TCD诊断的敏感性是77.8%,特异性是50%,阳性预测值53.8%,阴性预测值为75%。以I/C m BFV≥1.5为标准时,TCD的敏感性是71.8%,特异性是41.7%,阳性预测值50%,阴性预测值为71.4%。结论对于高Fisher分级的蛛网膜下腔出血的患者,TCD仍是预测迟发性脑缺血的有利工具。与I/C m BFV≥1.5为标准相比,m BFV≥120 cm/s的预测价值更高。Objective To investigate whether the predictive reliability of an increase in the mean blood flow velocity ratio of the ipsilateral to contralateral middle cerebral arteries （I/C mBFV） ≥120 cm/s is higher than that of the conventional absolute flow velocity （mBFV） for delayed cerebral ischemia （DCI） in higher modified Fisher grade. Methods Patients admitted into NICU of Beijing Tiantan Hospital, Capital Medical University from November 2011 to November 2013 who underwent transcranial Doppler sonography （TCD） and diagnosed with subarachnoid hemorrhage （SAH） ≥3 by modified Fisher grade were consecutively enrolled into study retrospectively. The mBFV value in bilateral middle cerebral arteries and I/C mBFV were recorded. The end point was delayed cerebral ischemia （DCI）. The I/C mBFV and middle cerebral artery mBFV ≥120 cm/s were calculated for predicting the sensitivity, specificity, positive predictive value and negative predictive value of DCI. Results A total of 44 patients were included in the study, among which, 18 patients developed DCI, with incidence rate of 41%. For middle cerebral artery mBFV ≥120 cm/s, the sensitivity, specificity, positive predictive value and negative predictive value of TCD in predicting DCI were 77.8%, 50%,53.8%, 75%, respectly. For I/C mBFV ≥1.5, the sensitivity, specificity, positive predictive value and negative predictive value of TCD in predicting DCI were 71.8%, 41.7%, 50%, 71.4%, respectively. Conclusion For SAH patients with higher modified Fisher grade, TCD was still an important tool for predicting DCI. The predictive value of mBFV ≥120 cm/s was higher than that of I/C mBFV≥1.5.

关 键 词：血流速度 脑血管痉挛 迟发性脑缺血 蛛网膜下腔出血 经颅多普勒 

分 类 号：R743.35[医药卫生—神经病学与精神病学]