TCD的特征频谱振荡波和钉子波在去骨瓣减压后患者脑死亡判定中的价值分析  

TCD characterized spectra oscillation wave and nail wave in determining brain death in patients accepted decompressive craniectomy

作　　者：廖苑[1] 刘华[2] 徐玲玲[2] 徐桂兴[3] Liao Yuan;Liu Hua;Xu Lingling;Xu Guixing(Organ Transplant Center,First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China;Department of Neurosurgery,First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China;Department of Pediatric,First Affiliated Hospital of Sun Yat-Sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院器官移植中心,广州510080 [2]中山大学附属第一医院儿科,广州510080 [3]中山大学附属第一医院神经外科,广州510080

出　　处：《中华神经医学杂志》2024年第6期571-577,共7页Chinese Journal of Neuromedicine

基　　金：广东省医学科研基金(A2019118)。

摘　　要：目的探讨经颅多普勒超声(TCD)的特征频谱(振荡波、钉子波)在行去骨瓣减压(DC)患者脑死亡判定中的价值。方法选择中山大学附属第一医院重症医学科自2021年1月1日至2023年12月31日收治的189例因神经重症致脑死亡患者,其中曾行DC患者51例(颅骨不完整组),未行DC患者138例(颅骨完整组)。颅骨不完整组中所有患者均行床旁TCD、脑电图(EEG)和诱发电位(EP)三项确认检查,颅骨完整组中47例患者行TCD、EEG和EP三项确认检查。比较2组患者临床资料和TCD特征频谱检出率的差异。分析当临床脑死亡至TCD检查的时间间隔<48 h、临床脑死亡至TCD检查的时间间隔≥48 h时,颅骨不完整组、颅骨完整组患者TCD与EEG、EP检查结果的一致率。采用单因素及多因素Logistic回归分析筛选颅骨不完整组患者TCD与EEG、EP检查结果一致的影响因素。结果颅骨不完整组与颅骨完整组患者的年龄、性别分布、脑损伤至临床脑死亡的时间间隔、临床脑死亡至TCD检查的时间间隔、TCD检查时收缩压的差异均无统计学意义(P>0.05)。与颅骨完整组比较,颅骨不完整组患者TCD特征频谱的检出率较高,差异有统计学意义(P<0.05)。当临床脑死亡至TCD检查的时间间隔≥48 h时,颅骨不完整组、颅骨完整组患者TCD与EEG、EP检查结果的一致率均为100%。多因素Logistic回归分析结果显示,临床脑死亡至TCD检查的时间间隔≥48 h是颅骨不完整组患者TCD与EEG、EP检查结果一致的独立影响因素(OR=7.313,95%CI:1.612~15.973,P=0.004)。结论临床脑死亡至TCD检查的时间间隔≥48 h时,TCD的"振荡波"和"钉子波"可作为行DC后患者脑死亡判定时的特征性表现。Objective To explore the values of transcranial Doppler(TCD)characterized spectra oscillatory wave and nail wave in determining brain death in patients accepted decompressive craniectomy(DC).Methods One hundred and eighty-nine patients with brain death caused by neurological severe diseases admitted to Department of Critical Care Medicine,First Affiliated Hospital of Sun Yat-sen University from January 1,2021 to December 31,2023 were enrolled:51 patients accepted DC(skull incomplete group)and 138 patients did not accept DC(skull intact group).TCD,electroencephalogram(EEG)and evoked potential(EP)were performed in all patients from the skull incomplete group and in 47 patients from the skull intact group.Differences in clinical data and detectable rate of TCD characterized spectra between the 2 groups were compared.Consistency of TCD results with EEG and EP results between the skull incomplete group and skull intact group was analyzed at time interval from brain death by clinical judgment to TCD<48 h or time interval from brain death by clinical judgment to TCD≥48 h.Univariate and multivariate Logistic regressions were used to analyze the influencing factors for consistency of TCD results with EEG and EP results in patients from the skull incomplete group.Results No significant difference in age,gender,time interval from brain injury to brain death by clinical judgment,time interval from brain death by clinical judgment to TCD,or systolic blood pressure during TCD was noted between the skull incomplete group and skull intact group(P>0.05).Detectable rate of TCD characterized spectra in skull incomplete group(92.16%)was significantly higher than that in the skull intact group(73.91%,χ^(2)=7.428,P=0.006).Consistency of TCD results with EEG and EP results in the skull incomplete group and skull intact group was both 100%at time interval from brain death by clinical judgment to TCD≥48 h.Multivariate Logistic regression analysis showed that time interval from brain death by clinical judgment to TCD≥48 h was an in

关 键 词：去骨瓣减压 脑死亡 经颅多普勒超声 振荡波 钉子波 

分 类 号：R651.15[医药卫生—外科学]