经颅多普勒超声检测对脑出血急性期预后判断的价值

Prognostic value of Transcranial Doppler examination in acute intracerebral hemorrhage

【目的】探讨脑出血病人脑血流动力学有关参数与CT脑血肿量和GCS评分的相关性,评价TCD对急性期脑出血预后判断价值。【方法】对起病≤12 h病人,头部CT确诊的78例幕上单侧自发性脑出血病人通过经颅多普勒(TCD)进行双侧大脑中动脉TCD检测和GCS评分。【结果】TCD双侧大脑中动脉PI值均明显升高,Vd及Vm呈现降低,Vs无明显变化;TCD有关参数与CT血肿量pearson相关系数分析,aPi和uPi P值均<0.001,Vd、Vs和Vm与CT血肿量大小无统计学显著性差异;ICP(颅内压)升高时,TCD最直接的特征是脑血流频谱的变化:即典型的"三峰形"频谱消失,出现收缩峰高尖、S1和S2峰融合、舒张期前切迹加深、搏动增加等;TCD参数与GCS评分pearson相关系数分析,PI值呈负性相关,并具有统计学显著性差异(P<0.0001)。【结论】TCD对急性期脑出血病人脑血流动力学的检测显示:及时反映颅内高压程度和脑血流灌注,为脑出血早期预后判断和及时调整治疗方案提供了简便有效方法。

[Objective]To inspect the dynamics parameter in brain blood stream by transcranial Doppler （TCD） in the patients with acute brain hemorrhage, to investigate the relativity among the parameter, hematoma amount, and GCS count, and then to evaluate the value of TCD examination in the prognosis of acute brain hemorrhage. [Methods]Double cerebral median of spontaneous acute brain hemorrhage patients which were in the disease within 12 hours were detected by TCD and were evaluated as GCS count, all the patients（78 cases） involved had been made final diagnosis by CT before that. [Results]PI value of double cerebral median in TCD detection ascended significantly, and the value of Vd and Vm descended, the Vs had no obvious changes. Through the dependability analysis there were no obvious differences among the Vd, Vs, Vm and the amount of hematoma（aPi〈0. 001, wPi P〈0. 001）. The TCD parameter and the GCS count had the statistical significant differences in the Pearson analysis, and the value of PI was negative correlation（ P 〈0. 0001）. [Conclusion] The value of PI in the TCD detection could be looked as an effectively haemodynamic index in the cases with acute brain hemorrhage.