经颅多普勒在前循环动脉瘤破裂致脑血管痉挛中的应用价值  

Application value of transcranial Doppler in cerebral vasospasm caused by anterior circulation ruptured aneurysm

作　　者：杜莉 潘源 宋维芹 贺西亮 辛涛 卢佩林 DU Li;PAN Yuan;SONG Weiqin;HE Xiliang;XIN Tao;LU Peilin(Department of Ultrasonography, No.971 Naval Hospital of PLA, Qingdao 266071, P.R.China;Department of Neurosurgery, No.971 Naval Hospital of PLA, Qingdao 266071, P.R.China)

机构地区：[1]中国人民解放军海军第九七一医院超声诊断科,山东青岛266071 [2]中国人民解放军海军第九七一医院神经外科,山东青岛266071

出　　处：《医学影像学杂志》2021年第1期1-4,共4页Journal of Medical Imaging

基　　金：山东省青岛市医药科研指导计划项目(编号:2019-WJZD168)。

摘　　要：目的探讨经颅多普勒(TCD)在前循环动脉瘤破裂致症状性脑血管痉挛中的应用价值。方法回顾性分析我院神经外科2010年4月~2020年4月收治的前循环动脉瘤性蛛网膜下腔出血,诊断为症状性脑血管痉挛的患者62例,所有患者在发病后连续每天行TCD检查,连续观察大脑中动脉血流速度,诊断为症状性脑血管痉挛后行脑血管造影检查(DSA),并行选择性脑动脉内盐酸法舒地尔灌注治疗,治疗后继续每日TCD监测;以DSA结果为标准,对比分析TCD诊断脑血管痉挛的准确性,分析TCD与DSA诊断痉挛程度的一致性。结果62例症状性脑血管痉挛患者,男性26例,女性36例,平均年龄(57.7±7.5)岁,其中前交通动脉瘤9例,大脑中动脉瘤21例,后交通动脉瘤32例;临床诊断症状性脑血管痉挛后,TCD诊断脑血管痉挛57例,行DSA检查,61例证实血管痉挛;TCD检出率93.4%(57/61)。选择性脑血管灌注法舒地尔前后,TCD测量M1平均血流速度,轻度痉挛组分别是(130.8±6.4)cm/s、(83.8±14.6)cm/s,中度痉挛组分别是(171.3±12.8)cm/s、(82.3±8.5)cm/s,灌注治疗效果明显,TCD血流速度有明显差异。术后TCD继续监测,4例患者在TCD血流速度再次升高后复查DSA,证实并治疗。结论针对前循环动脉瘤破裂所致症状性脑血管痉挛,TCD筛查检出率高;选择性脑血管内灌注治疗前后TCD血流速度有明显差异,可预测和指导下一步的动脉内治疗,并可作为治疗后的复查手段。TCD检查是症状性脑血管痉挛安全、有效、便捷的筛查手段。Objective To investigate the application value of transcranial Doppler(TCD)in symptomatic cerebral vasospasm caused by anterior circulation ruptured aneurysm.Methods Form Apr.2010 to Apr.2020,62 patients diagnosed as symptomatic cerebrovascular spasm,caused by anterior circulation aneurysmal subarachnoid hemorrhage,were retrospectively analyzed.All patients underwent continuous TCD examination every day after the onset of the disease to continuously observe the blood flow velocity of the middle cerebral artery.After diagnosis of symptomatic cerebral vasospasm,cerebral angiography(DSA)and selectivecerebral arterial infusion of fasudil hydrochloride were performed.Based on DSA results,the accuracy of TCD diagnosis of cerebral vasospasm was analyzed,and the consistency of TCD and DSA diagnosis of spasm was analyzed.Results A total of 62 patients met the statistical criteria,including 26 males and 36 females,with an average age of(57.7±7.5)years.There were 9 cases of anterior communicating aneurysm,21 cases of middle cerebral aneurysm,and 32 cases of posterior communicating aneurysm.After clinical diagnosis of symptomatic cerebral vasospasm,57 cases were diagnosed by TCD.DSA examination was performed and 61 were confirmed vasospasm;TCD detection rate was 93.4%(57/61).Before and after selective cerebrovascular infusion of fasudil,the average blood flow velocity of M1 measnred by TCD was(130.8±6.4)cm/s,(83.8±14.6)cm/s,respectively,in the mild group;and(171.3±12.8)cm/s,(82.3±8.5)cm/s,respectively,in themoderate group.The effect of infusion therapy was obvious,and the blood flow velocity of TCD was significantly different.Conclusion For the symptomatic cerebrovascular spasm caused by anterior circulation ruptured aneurysm,the TCD has a high positive rate;there is a significant difference in TCD before and after selective cerebrovascular infusion treatment,which has predictive value for the next condition and can provide a reference for the next treatment.TCD examina tion is a safe,effective and convenient screening

关 键 词：经颅多普勒 症状性脑血管痉挛 动脉瘤性蛛网膜下腔出血 

分 类 号：R743[医药卫生—神经病学与精神病学] R445.9[医药卫生—临床医学]