经颅多普勒超声在不可逆性昏迷患者脑功能判断中的作用

The application of transcranial Doppler in the evaluation of brain function in deeply comatose patients

目的分析经颅多普勒超声检测不可逆性昏迷患者的脑血流改变与脑功能临床判断的吻合性。方法对92例多种原因所致的格拉斯哥昏迷评分3分、脑干反射消失患者经颞窗探测双侧大脑中动脉;其中42例患者还经枕窗或枕旁窗探测基底动脉的血流频谱。以大脑中动脉为靶血管,以出现特征性频谱-振荡波、钉子波和血流信号消失任一判断为阳性。结果92例患者大脑中动脉第一次检查出现阳性结果68例,阳性率为73·9%;12h后检查,阳性病例74例,阳性率为80·4%。结论经颅多普勒超声可作为判断不可逆性昏迷患者脑功能不可逆终止的一项有效客观指标。

Objective To study the cerebral blood flow changes in irreversible comatose patients and investigate the correlation between the results of transcranial Doppler （TCD） and clinical evaluation of brain function. Methods TCD studies were performed in 92 patients who were excluded from the possibility of reversible coma and all of them had Glasgow Coma Scale of 3. Their brain stem reflections all disappeared. Detection of the blood flow in bilateral middle cerebral arteries was carried out through temporal window in all the patients and in 42 of the 92 cases the blood flow of the basilar artery was detected through occipital or peri-occipital window. Bilateral middle cerebral artery were taken as the main arteries for evaluation. The positive standard is the appearance of one of the following characteristic blood flow, i.e. brief systolic forward flow or systolic spikes and diastolic reverse flow, brief systolic forward flow or systolic spikes and no diastolic flow and no detectable flow signals. The examination was repeated after 12 h. Results 68 cases were positive in the initial examination （73.9%） and 74 cases were positive after 12 h （80. 4% ）. Conclusion TCD can be an effective and objective index in the evaluation of irreversible termination of brain function.