床旁经颅多普勒超声在神经重症脑血管疾病患者中的监测价值  

The Monitoring Value of Bedside Transcranial Doppler Ultrasound in Patients with Neurological Severe Cerebrovascular Diseases

作　　者：王煜姝[1] 王丽[1] 南宫晓霞 WANG Yushu;WANG Li;NANGONG Xiaoxia(Department of Neurophysiology,Zhengzhou People’s Hospital,Zhengzhou Henan 450000,China)

机构地区：[1]郑州人民医院神经电生理科,河南郑州450000

出　　处：《临床研究》2024年第4期121-123,共3页Clinical Research

摘　　要：目的分析神经重症脑血管疾病患者监测中床旁经颅多普勒超声应用效果。方法筛选郑州人民医院2021年5月至2023年5月86例重症脑血管疾病患者作为研究对象(高血压脑出血,术后35例,未手术者7例,脑动脉瘤破裂出血,术后32例,未手术者5例,其他脑血管疾病术后4例,未手术者3例),均采用经颅多普勒超声(TCD)监测,包含经枕窗探测基底动脉(BA)、经颞窗探测双侧大脑中动脉(MCA),另监测收缩期峰值血流动力学改变、舒张末期峰值血流速度、平均峰值血流速度、血管阻力指数、血管搏动指数、血流频谱形态等了解血流动力学改变,了解血流动力学改变,依照监测结果分三组,脑血管痉挛组(n=26)、供血不足组(n=37)、血流增快组(n=29),对各组监测结果予以分析。结果患者均完成TCD监测,在不同病因中,脑动脉瘤破裂出血与高血压脑出血患者供血不足发生率最高,其次是血流增快、血管痉挛,三组发生率对比差异有统计学意义(P<0.05)。结论在神经重症脑血管疾病患者中,床旁TCD监测能为临床治疗及预后评价提供有效支持。Objective To analyze the application effect of bedside transcranial Doppler ultrasound in the monitoring of patients with neurological severe cerebrovascular diseases.Methods 86 patients with severe cerebrovascular diseases who were admitted to Zhengzhou People’s Hospital from May 2021 to May 2023 were selected as the research objects(hypertensive cerebral hemorrhage,35 cases after surgery,7 cases without surgery,cerebral aneurysm rupture hemorrhage,32 cases after surgery,5 cases without surgery,other cerebrovascular diseases 4 cases after surgery,3 cases without surgery),all of which were monitored by transcranial Doppler ultrasound(TCD),including the detection of basilar artery(BA)through the occipital window,and the detection of bilateral middle cerebral artery(MCA)through the temporal window.In addition,the changes in peak hemodynamics during systole,peak blood flow velocity at the end of diastole,average peak blood flow velocity,vascular resistance index,vascular pulsation index,and blood flow spectrum morphology were monitored to understand the changes in hemodynamics.According to the monitoring results,they were divided into three groups:cerebral vasospasm group(n=26),insufficient blood supply group(n=37),and rapid blood flow group(n=29),and the monitoring results of each group were analyzed.Results All patients completed TCD monitoring.Among different etiologies,the incidence of insufficient blood supply was the highest in patients with cerebral aneurysm rupture and hemorrhage and hypertensive cerebral hemorrhage,followed by rapid blood flow and vasospasm.The difference in the incidence of the three groups was statistically significant(P<0.05).Conclusion In patients with neurological severe cerebrovascular diseases,bedside TCD monitoring can provide effective support for clinical treatment and prognosis evaluation.

关 键 词：重症 脑血管疾病 神经 床旁经颅多普勒超声 脑血流 监测 

分 类 号：R743[医药卫生—神经病学与精神病学]