急性非创伤性脑损伤昏迷患者大脑中动脉血流变化对其预后的影响  

Influence of middle cerebral artery blood flow on the prognosis of coma induced by acute non-traumatic brain injury

作　　者：吕宇 吕盛秋 黄京菊 覃涛[2] 杨叶桂 卢俊宇[2] 陈蒙华[2] LYU Yu;LYU Sheng-qiu;HUANG Jing-ju;QIN Tao;YANG Ye-gui;LU Jun-yu;CHEN Meng-hua(The Second Clinical Medical College,Guangxi Medical University,,Nanning,Guangxi Zhuang Autonomous Region 530000,China;Department of Intensive Care Unit,the Second Affiliated Hospital of Guangxi Medical University,Nanning,Guangxi Zhuang Autonomous Region 530000,China)

机构地区：[1]广西医科大学第二临床医学院 [2]广西医科大学第二附属医院重症医学科

出　　处：《中华实用诊断与治疗杂志》2023年第6期596-599,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：广西医疗卫生适宜技术开发与推广应用项目(S2020012)。

摘　　要：目的 应用经颅多普勒超声(transcranial Doppler ultrasound,TCD)观察急性非创伤性脑损伤昏迷患者大脑中动脉血流变化,探讨其与患者预后的关系。方法 格拉斯哥昏迷评分≤8分的急性非创伤性脑损伤昏迷患者45例,入ICU第1、3、7天应用TCD从颞窗采集脑血流动力学参数,包括大脑中动脉收缩期血流速度(peak systolic velocity,Vs)、舒张期血流速度(end-diastolic velocity,Vd)、平均血流速度(mean blood flow velocity,Vm)、搏动指数;记录外周桡动脉平均动脉压,计算脑血流指数。依据患者入ICU第28天格拉斯哥-匹兹堡脑功能表现分级分为恢复不良组(>3级)29例和恢复良好组(≤3级)16例,比较2组入ICU时格拉斯哥昏迷评分和体温、ICU住院时间,入ICU第1、3、7天血常规、动脉血气指标、神经元特异性烯醇化酶(neuron-specific enolase,NSE)水平及脑血流动力学参数。结果 恢复不良组入ICU时格拉斯哥昏迷评分[(3.2±0.8)分]低于恢复良好组[(4.4±1.4)分](t=3.427,P=0.003),入ICU时体温、ICU住院时间与恢复良好组比较差异均无统计学意义(P>0.05)。恢复不良组入ICU第3、7天NSE水平[36.0(20.0,193.5)、36.0(26.0,192.0)μg/L]均高于恢复良好组[21.0(13.0,24.5)、22.0(12.5,58.0)μg/L](t=-2.816,P=0.008;t=-2.063,P=0.048),第1天NSE水平及第1、3、7天血红蛋白、红细胞计数、红细胞压积、红细胞体积分布宽度、血小板计数、pa(O_(2))、pa(CO_(2))、实际碳酸氢根、血糖、血乳酸水平与恢复良好组比较差异均无统计学意义(P>0.05)。恢复不良组入ICU第1、3天大脑中动脉Vs[(120.1±41.2)、(120.7±37.5)cm/s]、Vd[(57.3±26.3)、(55.3±27.5)cm/s]、Vm[(78.3±30.0)、(77.1±29.5)cm/s]均高于恢复良好组[Vs(87.3±26.1)、(88.9±25.2)cm/s,Vd(36.3±20.2)、(37.7±17.8)cm/s,Vm(53.3±21.0)、(54.7±19.1)cm/s](P<0.05),第7天与恢复良好组比较差异均无统计学意义(P>0.05);恢复不良组入ICU第1、3、7天大脑中动脉搏动指数、平均动脉�Objective To observe the changes of middle cerebral artery blood flow in patients with acute non-traumatic brain injury induced coma by using transcranial Doppler ultrasound(TCD) and to explore its relationship with the prognosis.Methods Forty-five patients with acute non-traumatic brain injury induced coma,whose Glasgow coma score(GCS) was≤8,were collected the cerebral hemodynamic parameter as peak systolic velocity(Vs),end-diastolic velocity(Vd),mean blood flow velocity(Vm),and pulsatility index from the temporal window using TCD on the 1st,3rd and7th days after entering ICU.The mean arterial pressure of peripheral radial artery was recorded and the cerebral blood flow index was calculated.The Glasgow-Pittsburgh Scale of Brain Function Performance(CPC) on the 28th day after entering ICU was used to divided the patients into poor recovery group(CPC>3,n=29) and good recovery group(CPC ≤3,n=16),and the GCS score and body temperature at entering ICU,the length of ICU stay,and the routine blood routine,arterial blood gas index,neuron-specific enolase(NSE) level and cerebral hemodynamic parameters on the1st,3rd and 7th days after entering ICU were compared between two groups.Results The GCS was lower in poor recovery group(3.2±0.8) than that in good recovery group(4.4±1.4)(t=3.427,P=0.003),and there were no significant differences in the body temperature at entering ICU and the length of ICU stay between two groups(P>0.05).The levels of NSE on the 3rd and 7th days after entering ICU were higher in poor recovery group[36.0(20.0,193.5),36.0(26.0,192.0) μg/L] than those in good recovery group [21.0(13.0,24.5),22.0(12.5,58.0) μg/L](t=-2.873,P=0.008;t=-2.063,P=0.048),and there were no significant differences in the NSE level on the 1st day after entering ICU as well as the hemoglobin,red blood cell count,hematocrit,hematopoietic volume distribution width,platelet count,pa(O_(2))pa(CO_(2)),actual bicarbonate,blood glucose and blood lactic acid levels on the1st,3rd and 7th days after entering ICU between two groups(

关 键 词：急性非创伤性脑损伤 昏迷 经颅多普勒超声 大脑中动脉 血流动力学 

分 类 号：R651.15[医药卫生—外科学]