经颅多普勒在脑动脉瘤破裂介入术后脑血管痉挛诊断中的应用价值  

The value of transcranial Doppler in the diagnosis of cerebral vasospasm after intervention for ruptured cerebral aneurysm

作　　者：温铖彩 陈源锋[1] 陈小鑫[1] 吴强旺 WEN Chengcai;CHEN Yuanfeng;CHEN Xiaoxin;WU Qiangwang(Department of Neurosurgery,Longyan Second Hospital,Longyan 364000,China)

机构地区：[1]龙岩市第二医院神经外科,龙岩364000

出　　处：《上海医药》2024年第17期66-68,I0003,共4页Shanghai Medical & Pharmaceutical Journal

摘　　要：目的:探讨经颅多普勒(TCD)诊断脑动脉瘤破裂介入术后脑血管痉挛(CVS)的价值。方法:选取行TCD监测脑动脉瘤破裂介入术患者80例,探查患者大脑中动脉、颈内动脉入颅段的血流速度。以数字减影血管造影(DSA)检查结果为金标准,评估TCD诊断脑动脉瘤破裂介入术后CVS的价值。结果:术后1~14 d的大脑中动脉血流速度较术前高(P<0.05)。DSA检查确诊介入术后发生CVS者42例。CVS组患者术后1~14 d的大脑中动脉血流速度均高于非CVS组患者(P<0.05)。TCD诊断脑动脉瘤破裂介入术后CVS的准确度、灵敏度、特异度>80%(Kappa=0.726)。42例CVS患者用尼莫地平治疗后病情逐渐减轻,大脑中动脉血流速度恢复正常,均未发生偏瘫及死亡。结论:TCD可监测脑动脉瘤破裂介入术后大脑中动脉血流速度的变化,为临床诊断CVS提供可靠依据。Objective:To investigate the value of transcranial Doppler(TCD)in the diagnosis of cerebral vasospasm(CVS)after intervention of cerebral aneurysm rupture.Methods:Eighty patients were selected to undergo TCD monitoring of the intervention of cerebral aneurysm rupture,and the blood flow velocities of the middle cerebral artery and internal carotid artery into the cranial segment in the patients were explored.The value of TCD in diagnosing CVS after the intervention of cerebral aneurysm rupture was evaluated using digital subtraction angiography(DSA)findings as a gold standard.Results:The blood flow velocity of the middle cerebral artery was higher 1-14 d after surgery than before operation(P<0.05).DSA examination confirmed that CVS occurred in 42 cases after intervention.The blood flow velocity of the middle cerebral artery was higher in the CVS group than the non-CVS group 1-14 d after surgery(P<0.05).The accuracy,sensitivity,and specificity of TCD in diagnosing CVS after intervention for cerebral aneurysm rupture were over 80%(Kappa=0.726).Forty-two patients with CVS gradually reduced their condition after treatment with nimodipine,and their middle cerebral artery blood flow velocity returned to normal and no hemiparesis or death occurred.Conclusion:TCD can monitor the changes of middle cerebral artery blood flow velocity after cerebral aneurysm rupture and provide a reliable basis for clinical diagnosis of CVS.

关 键 词：脑动脉瘤 经颅多普勒 脑血管痉挛 大脑中动脉 血流速度 

分 类 号：R445.1[医药卫生—影像医学与核医学] R651.2[医药卫生—诊断学]