经颅多普勒诊断脑血管痉挛的对比分析

Transcranial Doppler in diagnosis of cerebral vasospasm-A comparative study

目的通过应用经颅多普勒(TCD)检测蛛网膜下腔出血患者的颅内血流状况,诊断脑血管痉挛(CVS)并经过数字减影血管造影(SDC)证实,说明TCD诊断CVS的可靠性。方法应用TCD检测2000-2005年CT已经明确诊断为蛛网膜下腔出血Ⅰ～Ⅲ级患者49例(Ⅳ～Ⅴ级患者病情严重不宜做血管造影检查,因此不做讨论)。于患病后第1天开始,每隔3d监测一次,动态观察10d。观察血管参数:大脑中动脉(MCA)、颈内动脉终末段(TICA)、颈内动脉颅外段(ICA)的收缩期峰值流速(Vs)、平均血流速度(Vm)以及大脑中动脉与颈内动脉颅外段(ICA)峰值流速的比值(∨MCA/∨ICA),同时行SDC检查证实。结果49例患者中,TCD提示CVS者26例,痉挛条数33条。数字减影血管造影结果显示CVS者31例,痉挛条数36条,TCD诊断CVS的敏感率为83.8%,TCD诊断CVS特异性为91.6%。结论TCD技术与SDC相比具有操作简便、价廉、实时无创、敏感有效,容易重复检查等优点。

Objective The purpose of this study is to evaluate intracranial blood flow conditions in patients with subarachnoid hemorrhage with transcranial Doppler （TCD） , and to investigate the reliability of TCD in diagnosis of cerebral vasospasm （CVS） by comparing with the subtraction digital angiography （SDC） result. Methods 49 patients who underwent TCD examination between 2000 and 2005 were involved in this study. All the patients had appearance of subarachnoid hemorrhage for grade Ⅰ-Ⅲ on computerized tomography （CT） scan （grade Ⅳ-Ⅴ were excluded because too serious to endure angiography）. From the first day of making a definite diagnosis, TCD were performed every three days, and the observation lasted for ten days. Evaluated pa- rameters included：The Peak and mean velocity（ Vs and Vm）of Middle cerebral artery（MCA） , Distal internalcarotid artery（TICA） and Extracranial internal carotid artery（EICA）. Ratio of MCA and EICA（VMCA/VICA） was calculated,and SDC for each person were also performed. Results Among the 49patients, TCD suggested 26 were CVS, and 33 vasospasm vessels in total. SDC results showed there were 31CVS patients, and 36 vasospasm vessels in total. Specification of TCD in CVS diagnosis was 83.8%, and the specification was 91.6%. Conclusion Compared with the SDC, TCD has its advantages for flexible operations, low cost, real-time and non-invasive, sensitive and effective, and good reproducibility.