经颅多普勒超声在昏迷危重患儿中的应用

Application of transcranial Doppler to seriously illed children with coma

目的应用经颅多普勒超声(TCD)观察昏迷患儿脑血流动力学的一般情况及变化趋势,以及了解脑血流动力学与颅内压之间的联系。方法以大脑中动脉(MCA)为靶血管,观察昏迷组及对照组患儿(其中56例昏迷患儿)脑血流变化;腰穿或应用甘露醇前后各指标的变化;昏迷患儿不同时期及不同昏迷程度时的各指标的变化。结果昏迷组收缩期峰流速(Vp)、平均血流速度(Vm)、脉动指数(PI)、阻力指数(RI)明显高于对照组;昏迷患儿在治疗前Vp、Vm、PI、RI均高于治疗后;患儿在腰穿前大脑中动脉Vp、Vm、PI、RI均高于腰穿后;甘露醇使用前Vp、Vm、PI、RI均高于其使用后;Glasgow评分分值低者Vp、舒张期流速(Vd)、Vm偏低,而RI、PI偏高。结论昏迷患儿的脑血流动力学异于正常,TCD可反映颅内脑血流灌注情况,脑血流动力参数可随颅内压而变;因此TCD有助于判断病情、指导临床治疗和评估预后。

Objectives To investigate changes of the cerebral blood flow in comatose patients and the correlation between the results of transcranial Doppler （TCD） and intracranial pressure. Methods The blood flow changes of right side middle cerebral artery （MCA） were monitored by TCD in 97 patients （56 comatose patients）; peak velocity （Vp）, diastolic velocity （Vd）, mean velocity （Vm）, resistant index （RI） and pulsatility index （PI） of MCA were monitored before and after lumbar puncture or bolus of mannitol administration; such indices were monitored in comatose cases at different levels of coma in different period. Results （ 1 ） Vp, Vm, RI and PI of MCA in comatose patients were higher than those in control group; （2） Vp, Vm, RI and PI decreased during the fifth and seventh day after admission; （3） Vp, Vm, RI and PI before lumbar puncture or bolus of mannitol administration were higher than those after such intervention. （4） Vp, Vd, Vm of MCA in comatose patients with low score of Glasgow scale （improved） were lower than those with more score, while RI and PI were on the contrary. Condusions The cerebral blood flow in most of comatose patients was abnormal; results of TCD may reflex the cerebral blood perfusion and change in intracranial pressure. TCD could be helpful in judging patient＇ s condition, guiding treatment and evaluating prognosis.