TCD大脑中动脉峰值流速在分级不良性颅内动脉瘤中的应用研究  

Application of peak flow velocity of the middle cerebral artery on transcranial Doppler in poor-grade intracranial aneurysm

作　　者：亢志强 杜宝顺[1] 孙来广[1] 刘猛[1] KANG Zhi-Qiang;DU Bao-Shun;SUN Lai-Guang;LIU Meng(Department of neurosurgery,Xinxiang central hospital,Xinxiang,453000,China)

机构地区：[1]新乡市中心医院神经外科,河南新乡453000

出　　处：《国际神经病学神经外科学杂志》2020年第1期18-21,共4页Journal of International Neurology and Neurosurgery

基　　金：新乡市重点科技攻关计划项目(2G14016)。

摘　　要：目的探究经颅多普勒超声(transcranial cloppler,TCD)在分级不良性颅内动脉瘤(Hunt-HessⅢ~Ⅴ级)患者中的应用价值。方法监测56例分级不良性颅内动脉瘤患者不同时间窗大脑中动脉的血流动力学参数:平均流速(Vm)和峰值流速(Vp),随机分为2组;Vm组(28例):依据临床表现及Vm调整尼莫地平用量,Vp组(28例):依据临床表现及Vp调整尼莫地平用量;组内根据年龄是否≥60岁分为老年组和中年组;SAH 3个月后采用GOS评分评价患者预后,进行组间差异性分析。结果Vm组:预后不良14例,良好14例;Vp组:预后不良12例,良好16例;2组患者预后无明显差别,差异无统计学意义(P>0.05)。中年Vm组:预后不良6例,良好11例;Vp组:预后不良9例,良好4例;2组患者预后无明显差别,差异无统计学意义(P>0.05)。老年Vm组:预后不良8例,良好3例;Vp组:预后不良3例,良好9例;老年Vp组患者预后明显优于Vm组,差异有统计学意义(P<0.05)。结论TCD可以实时无创地监测颅内动脉瘤患者的血流动力学变化,为其个体化治疗提供理论依据。Objective To investigate the application value of transcranial Doppler(TCD)in patients with poor-grade intracranial aneurysm(Hunt-Hess III to V).Methods Hemodynamic parameters of the middle cerebral artery were monitored for 56 patients with poor-grade intracranial aneurysm at different time windows,including mean flow velocity(Vm)and peak flow velocity(Vp).The patients were randomly divided into Vm group with 28 patients(the dose of nimodipine was adjusted according to the clinical manifestations and Vm)and Vp group with 28 patients(the dose of nimodipine was adjusted according to the clinical manifestations and Vp).Each group was further divided into the elderly group and the middle-aged group according to whether the age was≥60 years.At 3 months after subarachnoid hemorrhage(SAH),Glasgow Outcome Scale(GOS)score was used to evaluate patients'prognosis,and a comparative analysis was performed between the two groups.Results In the Vm group,there were 14 patients with poor prognosis and 14 patients with good prognosis,and in the Vp group,there were 12 patients with poor prognosis and 16 patients with good prognosis;there was no significant difference in prognosis between the two groups(P>0.05).In the middle-aged Vm group,there were 6 patients with poor prognosis and 11 patients with good prognosis,and in the middle-aged Vp group,there were 9 patients with poor prognosis and 4 patients with good prognosis;there was no significant difference in prognosis between the two groups(P>0.05).In the elderly Vm group,there were 8 patients with poor prognosis and 3 patients with good prognosis,and in the elderly Vp group,there were 3 patients with poor prognosis and 9 patients with good prognosis;the elderly Vp group had a significantly better prognosis than the elderly Vm group(P<0.05).Conclusions TCD can achieve the noninvasive and real-time monitoring of hemodynamic changes in patients with poor-grade intracranial aneurysm,so as to provide a theoretical basis for individualized treatment.

关 键 词：经颅多普勒超声 颅内动脉瘤 脑血管痉挛 蛛网膜下腔出血 血流动力学 

分 类 号：R743.35[医药卫生—神经病学与精神病学] R445.1[医药卫生—临床医学]