经颅多普勒在颅内感染和脑出血初期颅高压的对比研究

Intracranial hypertension in early stage of intracranial infection and intracerebral hemorrhage: comparative study with transcranial Doppler

目的观察经颅多普勒(TCD)频谱参数在颅内感染和脑出血患者初期颅高压的相关变化,进而预测颅内压(ICP)和脑灌注压(CPP)并比较TCD预测的准确性。方法对42例颅内感染患者128次腰穿和45例脑出血患者138次腰穿测压前均行TCD检查并记录血压。结果随着ICP升高,颅内感染和脑出血TCD均表现出高阻力血流频谱,收缩期血流速度(Vs)无明显变化,舒张期血流速度(Vd)减慢,血管博动指数(PI)增大。颅内感染颅内动脉血流速度明显快于脑出血(P<0.01),平均动脉压、脑灌注压明显低于脑出血(P<0.01)。颅内感染TCD参数、平均动脉压(MAP)与ICP、CPP的回归方程分别为:ICPe=1.026+17.165×PI;CPPe=1.411-17.091×PI+0.971×MAP。预测和实测ICP、CPP相关系数分别为0.594、0.910。ICP预测差值在5mmHg内阳性预测率为63.28%,CPP为62.5%。脑出血TCD相关参数与ICP、CPP的逐步回归方程分别为:ICPe=-7.096+20.474×PI+0.053×MAP;CPPe=7.096-20.474×PI+0.947×MAP。预测和实测ICP、CPP相关系数分别为0.796、0.977,预测差值在5mmHg内阳性预测率均为89.91%。结论颅内感染多合并炎性血管痉挛,根据特征性TCD频谱参数改变可较准确预测ICP、CPP,对脑出血的预测准确性好于颅内感染。

Objective To observe the spectra and parameter changes of transcranial Doppler （TCD） in early stage of intracranial hypertension of intracranial infection and intracerebral hemorrhage （ICH） to predict the intracranial pressure （ICP） and cerebral perfusion pressure （CCP）. Methods TCD examination was carried out before lumbar puncture for pressure testing in 42 intracranial infection patients （128 times） and 45 ICH patients （138 times）. Results With the increase of ICP, TCD showed high resistance spectra, blood flow velocity didn＇t change in systole stage （Vs）, while decreased in diastole stage （Vd） and pulsability index （PI） increased. Blood flow velocity in intracranial infection patients was faster than that in ICH patients （P〈0. 01）, while mean arterial blood pressure （MAP） and cerebral perfusion pressure were lower than those in ICH patients （P〈0.01）. Stepwise regression equation of TCD in intracranial infection patients and ICP ＆ CPP was ICPe= 1. 026＋ 17. 165 × PI; CPPe= 1. 411-17. 091 ×PI＋0. 971 × MAP. Predicted and actual correlation coefficients were 0. 594 and 0. 910 respctively. Positive predictive rate within 5 mmHg in ICP was 63.28%, and CPP was 62.5%. Stepwise regression equations of TCD in ICH patients and ICP ＆ CPP were ICPe=-7. 096＋20. 474 ×PI＋0. 053 × MAP, CPPe= 7.096-20. 474 × PI＋0. 947 × MAP. Predicted and actual correlation coefficients of ICP ＆ CCP were 0. 796 and 0. 977 separately. Positive predictive rate within 5 mmHg was 89.91%. Conclusion Intracranial infection is always accompanied with inflammatory angiospasm, ICP ＆ CCP can be predicted accurately according to typical change of TCD parameter. Prediction accuracy of TCD in ICH is better than that in intracranial infection.