经颅多普勒超声监测脑功能损害危重患儿的临床研究  

Clinical Study of Transcranial Doppler Ultrasonography in Monitoring Critically Ill Children with Cerebral Dysfunction

作　　者：司文静 SI Wen-jing(Children’s Hospital Affiliated to Zhengzhou University,Henan Children’s Hospital,Zhengzhou Chil-dren’s Hospital,Zhengzhou,Henan,450000,China)

机构地区：[1]郑州大学附属儿童医院·河南省儿童医院,河南郑州450000

出　　处：《黑龙江医学》2022年第20期2472-2475,共4页Heilongjiang Medical Journal

摘　　要：目的:探讨经颅多普勒超声(TCD)监测在脑功能损害危重患儿中的运用价值。方法:选取2018年10月-2019年10月于郑州大学附属儿童医院内科重症监护室(PICU)住院治疗并行TCD监测的68例患儿作为研究对象,其中脑损组37例,无脑损组31例,对比两组患儿TCD参数,即大脑中动脉(MCA)的脑血流动力学参数[平均流速(Vm)、收缩期峰流速(Vs)、舒张期末流速(Vd)、搏动指数(PI)及阻力指数(RI)]。另外根据患儿入院时的格拉斯哥昏迷量表(GCS)评分再将脑损组患儿分为重度脑损组(评分≤6分,n=17例)及轻中度脑损组(评分6~13分,n=20例)。半年后随访并根据患儿是否存在脑功能障碍再将脑损组分为预后好组(n=24例)及预后差组(n=13例),对比不同GCS评分及预后患儿的脑血流动力学各参数测量值、意识障碍持续时间(T1)与TCD参数恢复正常所用时间(T2),并对TCD参数恢复正常所用时间与入院GCS评分及意识障碍持续时间进行相关性分析。结果:脑损组Vs、PI、RI均较无脑损组高而Vd较无脑损组低,差异有统计学意义(t=4.070、7.897、8.246、2.607,P<0.05),Vm比较差异无统计学意义(t=1.395,P>0.05)。重度脑损组PI较轻中度脑损组高,差异有统计学意义(t=2.091,P<0.05),而Vm、Vs、Vd、RI比较,差异无统计学意义(t=0.096、0.204、0.353、1.137,P>0.05)。预后好组与预后差组TCD各参数比较,差异无统计学意义(t=0.287、0.460、0.003、0.769、0.620,P>0.05)。重度脑损组与预后差组T1与T2均较轻中度脑损组与预后好组更长,差异有统计学意义(t=12.769、6.358,P<0.05)。脑损组TCD参数恢复正常所用时间与入院GCS评分呈负相关,差异有统计学意义(r=-0.649,P=0.013),而与意识障碍持续时间呈正相关,差异有统计学意义(r=0.879,P=0.021)。结论:连续动态TCD监测可反应脑功能损伤患儿脑血流动力学的异常变化,且脑损程度越重则PI值越高、意识障碍持续时间及TCD参数恢复正常所用时Objective:To explore the value of transcranial Doppler(TCD)monitoring in critically ill children with brain damage.Methods:A total of 68 children who were hospitalized in the hospital’s internal intensive care unit(PICU)and underwent TCD monitoring from October 2018 to October 2019 were selected as the research subjects,including 37 cases in the brain damage group and 31 cases in the no brain damage group.The TCD parameters of the two groups were compared,namely the cerebral hemodynamic parameters of the middle cerebral artery(MCA)(mean flow velocity[Vm],peak systolic flow velocity[Vs],end diastolic flow velocity[Vd],pulsatility index[PI]and resistance Index[RI]).In addition,according to the Glasgow Coma Scale(GCS)score on admission,the children in the brain injury group were divided into a severe brain injury group(score≤6 points,n=17)and a mild to moderate brain injury group(score 6-13 points,n=20).After six months of follow-up,the brain damage group was divided into a good prognosis group(n=24)and a poor prognosis group(n=13)according to whether the children had brain dysfunction.The measured values of cerebral hemodynamic parameters,the duration of disturbance of consciousness(T1)and the time it took for TCD parameters to return to normal(T2)were compared in children with different GCS scores and prognosis.The correlation analysis was performed on the time taken for TCD parameters to return to normal,the admission GCS score and the duration of disturbance of consciousness.Results:The Vs,PI and RI of the brain damage group were higher than those of the no brain damage group,and the Vd was lower than that of the no brain damage group,and the difference was statistically significant(t=4.070,7.897,8.246,2.607,P<0.05).There was no statistically significant difference in Vm between groups(t=1.395,P>0.05).The PI in the severe brain injury group was higher than that in the mild and moderate brain injury group,and the difference was statistically significant(t=2.091,P<0.05).There was no statistically significant d

关 键 词：脑功能损害 经颅多普勒超声 脑血流动力学 

分 类 号：R445[医药卫生—影像医学与核医学]