TCD观察动脉瘤性SAH后脑血管痉挛的血流动力学改变

Hemodynamic changes of cerebrovascular in aneurysmal subarachnoid hemorrhage by TCD

目的探讨动脉瘤性蛛网膜下腔出血（SAH）后脑血管痉挛的血流动力学改变.方法经CT、DSA证实为动脉瘤性SAH患者179例,床旁经颅超声多谱勒（TCD）在术前、术后1～3d、5～7d、9～11d、12～14d记录并分析大脑中动脉（MCA）的血流参数及频谱改变.结果 MCA平均血流速度（Vm）于SAH后1～3d开始升高,5～7d、9～11d达到高峰;LI（血管痉挛指数）为3～6时预后良好;〉6时可以出现神经系统功能损害,颅内压增高且有脑血管痉挛（CVS）者预后较差.结论 TCD能无创、实时评价SAH后CVS的动态变化,可以推断SAH后CVS的严重程度及临床转归.

Objective To explore hemodynamic changes of cerebral vasospasm after aneurysmal subarachnoid hemorrhage（SAH）. Methods 179 patients with aneurysmal SAH were examined by CT and DSA. Blood flow parameters and plateau waves of middle cerebral artery（MCA）were recorded and analyzed with bedside transcranial Doppler ultrasonography （TCD） before operation and at 1 ～ 3d, 5 ～ 7d, 9 ～ 1 ld, 12 ～ 14d after operation. Resuits Mean flow velocity（Vm）in MCA augmented at 1～3d and reached peak at 5～7d and 9～11d after SAH. There will be a better outcome if Lindegaard index in 3～ 6. However,there would be higher mortality and neurological deficits when Lindegaard index over 6,intracranial hypertension and cerebral vasospasm. Conclusion TCD could detect the dynamic hemodynamic changes in noninvasive way and timely following SAH can be useful for diagnosis and prognosis of CVS.