经颅多普勒监测在脑动脉瘤术后脑血管痉挛诊断治疗中的应用

Application of transcranial doppler for postoperative cerebral vasospasm following ruptured aneurysms

目的:探讨脑动脉瘤术后脑血管痉挛的经颅多普勒(TCD)监测的应用价值。方法:对2000年3月～2007年6月间234例脑动脉瘤破裂术后的患者在3d内急诊行动脉瘤夹闭术,术后患者分为2组,治疗组120例行人工脑脊液脑池冲洗,对照组114例常规腰穿引流血性脑脊液,所有患者术后第1、3、5、7、10d应用TCD进行监测,根据TCD监测到的脑血管痉挛程度调整治疗方案,并对比疗效。结果:TCD可及时发现术后脑血管痉挛的发生,判断痉挛的程度,追踪其发展过程并指导治疗,治疗组患者中重度脑血管痉挛和症状性脑血管痉挛发生率显著低于对照组(P<0.05)。结论:TCD监测可早期发现脑血管痉挛,指导医师及时调整治疗,人工脑脊液冲洗治疗可以减少严重并发症的发生。

Objective：To estimate the value of transcranial doppler（TCD）for detection of postoperative cerebral vasospasm and to evaluate the effects of intracistern elutriation with artifiticial cerebrospinal fluid to prevent vasospasm after clipping ruptured intraeranial aneurysm.Methods：From March of 2000 to June of 2007,234 patients received surgery for clipping intracranial aneurysm ruptured within 3 days.The patients were divided into two groups.The treatment group had 120 cases.In this group the irrigating and draining tube were put into optic cistern and sylvian fissure and intracistern elutriation with artifiticial cerebrospinal fluid started right after surgery.The other 114 cases received lumber puncture and continuous CSF drainiage as control group. All of the patients underwent TCD at 1,3,5,7,10 days after surgical clipping of the aneurysm.According to the degree of vasospasm recorded by TCD, the amount of irrigation fluid or the dose of anti vessel spasms agents were adjusted.The incidences of the vasospasm in two group were compared statistically.Results：TCD could detect the cerebral vasospasm and evaluate its degree in the early stage.Furthermore the TCD could trace the whole developing process of the cerebral vasospasm and guide our therapeutic intervention.The occurrence of the moderate and severe cerebral vasospsm monitored by TCD was less in treatment group and the incidence of symptomatic vasospasm was also lower in treatment group （P〈0.05）.Conclusion：TCD is an usefull tool in early detection of cerebral vasospasm after surgery for ruptured aneurysm.The intracistern elutriation with artificial cerebralspinal fluid effectively reduces the occurrence of severe cerebral vasospasm and improves the surgical results for ruptured aneurysm patients.