经颅多普勒监测下过度通气治疗重型颅脑损伤患者的临床研究  

Clinical study of hyperventilation therapy in severe traumatic brain injury by transcranial doppler monitoring

作　　者：赵恺[1] 韩林 胡娜[1] 杜晓亮 厉春林[1] 张华楸 Zhao Kai;Han Lin;Hu Na;Du Xiaoliang;Li Chunlin;Zhang Huaqiu(Department of Neurosurgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经外科

出　　处：《中华危重症医学杂志（电子版）》2019年第5期306-310,共5页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：国家自然科学基金青年基金项目（81602204）;湖北省卫生健康委员会重点支撑项目（WJ2019Z008）

摘　　要：目的探讨经颅多普勒(TCD)监测下调整过度通气治疗策略对重症颅脑损伤(sTBI)患者的疗效。方法将59例sTBI患者分为对照组(30例)和实验组(29例),对照组采用过度通气治疗,实验组在对照组基础上,根据TCD监测的脑血管痉挛(CVS)程度调整通气治疗策略。监测两组患者治疗前后大脑中动脉(MCA)的平均血流速度(Vm),并计算治疗前后的平均血流速度变化值(ΔVm)。同时,将两组sTBI患者分为无CVS组(Vm<120 cm/s)、轻度CVS组(120≤Vm<140 cm/s)、中重度CVS组(Vm≥140 cm/s),对各亚组间的ΔVm进行比较。采用格拉斯哥结局量表(GOS)对两组患者治疗6个月后的疗效进行评估。结果实验组患者ΔVm显著高于对照组患者[22.0(13.0,39.5)cm/s vs.10.0(7.0,26.3)cm/s,H=2.527,P=0.012]。对照组和实验组不同CVS程度患者间ΔVm比较,差异有统计学意义(H=20.276,P=0.001);实验组中,轻度CVS组及中重度CVS组均显著高于无CVS组[23.0(21.5,41.0)、40.0(22.5,52.0)、13.0(9.8,18.0)cm/s],且中重度CVS组更高(P均<0.05);且对于中重度CVS患者,实验组的ΔVm明显较对照组增加[40.0(22.5,52.0)cm/s vs.9.0(8.0,31.0)cm/s,P<0.05]。治疗6个月后实验组GOS评分整体优于对照组(u=2.059,P=0.045)。结论根据TCD监测结果调整过度通气治疗策略有利于缓解CVS,改善sTBI患者的疗效。Objective To investigate the effect of appropriate hyperventilation therapy based on transcranial doppler(TCD)monitoring in patients with severe traumatic brain injury(sTBI).Methods Totally 59 sTBI patients were divided into the control group(30 cases)and experimental group(29 cases)randomly.Patients in the control group were treated with hyperventilation,and patients in the experimental group received mild hyperventilation ventilation therapy according to the cerebral vasospasm(CVS)monitored by TCD.The blood flow mean velocity(Vm)and variation of Vm(ΔVm)before and after treatment in the middle cerebral artery(MCA)were detected.At the same time,patients in the two groups were further divided into the non-CVS group(Vm<120 cm/s),mild CVS group(120≤Vm<140 cm/s)and moderate-severe CVS group(Vm≥140 cm/s).TheΔVm among each subgroup was compared.The effect after 6 months of treatment between the two groups was assessed by the Glasgow outcome scale(GOS).Results TheΔVm was much higher in the experimental group than in the control group[22.0(13.0,39.5)cm/s vs.10.0(7.0,26.3)cm/s,H=2.527,P=0.012].The ΔVm with different CVS degrees between two groups was significantly different(H=20.276,P=0.001).In the experimental group,the ΔVm was much higher in the mild CVS group and moderate-severe CVS group than in the non-CVS group[23.0(21.5,41.0),40.0(22.5,52.0),13.0(9.8,18.0)cm/s],and it was highest in the moderate-severe CVS group(all P<0.05).For patients with moderate-severe CVS,theΔVm was also much higher in the experimental group than in the control group[40.0(22.5,52.0)cm/s vs.9.0(8.0,31.0)cm/s,P<0.05].The GOS score after 6 months of treatment was much better in the experiment group than in the control group(u=2.059,P=0.045).Conclusion The hyperventilation therapy based on TCD monitoring can play a pivotal role in alleviating CVS and improving the efficacy of sTBI patients.

关 键 词：超声检查 多普勒 经颅 通气过度 颅脑损伤 

分 类 号：R74[医药卫生—神经病学与精神病学]