不同类型急性脑损伤患者脑血流和脑血管反应性的动态变化及临床意义

The Dynamic Changes and Clinical Significance of Cerebral Blood Flow and Cerebral Vessels Responsivity in different Types of Acute Brain Injured Patients

目的应用经颅多普勒超声(TCD),检测外伤性脑损伤和缺血缺氧性脑病患者脑血管血流变化,探讨脑血流及其反应性变化的临床意义。方法应用TCD检测对照组、外伤性脑损伤(TBI)和心肺复苏后缺血缺氧性脑病患者(HIE),观察大脑中动脉血流参数(收缩峰、舒张期末、平均血流速度及搏动和阻力指数)变化,以及病程第1、3、5d的脑血管二氧化碳反应性,评价其与预后的关系。结果HIE与对照组相比,大脑中动脉舒张末流速与平均流速明显降低,而脉搏指数和阻力指数明显增加(P值均<0.05)。TBI与对照组间除收缩峰流速外均无明显差异;而与HIE组相比,除阻力指数外,其它血流参数均存在明显差异。HIE和TBI患者脑血管对二氧化碳反应性均呈现先下降后上升的趋势,并且脑血管的反应性与患者预后明显相关。结论不同类型脑损伤脑血流的变化不同,但其脑血管反应性的变化均可评估患者预后。

Objective To detect traumatic brain injury（TBI） and hypoxic-ischemic encephalopathy（HIE） patients by the Transcranial Doppler and investigate the changes of the cerebral blood flow and cerebral vascular reactivity and their clinical value.Methods To detect control group, TBI group and HIE group by the Transcranial Doppler and observe the changes of Middle Cerebral Artery parameters （Systole Peak Velocity, Diastole End Velocity, Mean Blood Flow Velocity, Pulsatility Index, Resistant Index） and their responsivity to carbon dioxide in first day, third day, fifth day of during the disease and to appreciate their relations with prognosis.Results The diastole end velocity and mean blood flow velocity velocity of MCA in HIE groups were obviously decrease contrasted with these in control group, while PI and RI were obviously increase （P〈0.05）.Only Systole Peak Velocity was different in TBI and control and TBI groups.Cerebral Vessels Responsivity to carbon dioxide showed the tendency of descending firstly and then ascending in TBI and TBI groups.There was no obvious discrepancy in two groups. While patient prognosises were obviously correlated with Cerebral Vessels Responsivity.Conclusion The changes of Cerebral Blood Flow are different in different types of brain injured patients,but the changes of Cerebral Vessels Responsivity could evaluate patients prognosis.