原发性脑出血急性期经颅多普勒血流参数变化规律

Changes of Haemodynamic Parameters of Transcranial Doppler in Acute Intracerebral Hemorrhage

目的探讨原发性脑出血(spontaneous intracerebral hemorrhage,ICH)急性期经颅多普勒(transcranialdoppler,TCD)超声血流参数变化规律及与30d死亡的相关性。方法前瞻性入组87例首次发病24h以内,原发幕上脑出血患者。按照出血量分为小量出血组(n=21)、中量出血组(n=27)和大量出血组(n=59)。入组患者发病24h内行颅脑计算机断层扫描(computed tomography,CT)检查。于发病24h内、第3、7、14d行床旁TCD监测,记录双侧大脑中动脉收缩期峰值血流速度(systolic velocities,Vs)、舒张期血流速度(diastolic velocities,Vd)、平均血流速度(mean velocities,Vm)、搏动指数(pulsatility index,PI)、阻力指数(resistive index,RI)。其中48例患者完成全部TCD监测。对各组血流动力学参数进行比较。结果发病24h以内,小量出血组血流动力学参数接近正常值;中量、大量出血组健侧Vm降低(P<0.01),双侧Vd降低(患侧:P<0.01;健侧P<0.01),双侧PI、RI(患侧:P=0.001;健侧:P<0.01)升高,大量出血组较中量出血组变化明显。脑出血发病14d以内双侧Vm值呈持续下降趋势。30d死亡患者健侧Vd比存活患者显著降低(P<0.01),双侧PI,RI升高(P<0.01)。结论 TCD血流参数的变化可以反映脑出血急性期颅内血流变化规律,是评估预后的重要指标。

Objective To investigate the brain blood stream changes that recorded by transcranial Doppler （TCD） during acute stage of the spontaneous intracerebral hemorrhage and its relationship with 30-day death. Methods We prospectively included 87 patients with first-ever supratentorial, nontraumatic ICH. CT and TCD examination were performed in the acute stage （less than 24 hours from symptom onset）. All 48 patients completed 4 times TCD examinations on the 1st, 3rd, 7th, 14th day after onset. TCD recordings were obtained from the middle cerebral arteries, following variables were analyzed： systolic（Vs）, diastolic （Vd）, mean （Vm）velocities, pulsatiliy index and resistive index from the affected and unaffected hemispheres. Results TCD variables of small-volume group within 24 hours from symptom onset were normal. Vm in unaffected hemisphere （P〈0.01） and Vd in both hemispheres （affected hemisphere： P〈0.01; unaffected hemisphere： P〈0.01）in large-volume group were lower than those in mid-volume and small-volume groups. PI （affected hemisphere： P〈0.001; unaffected hemisphere： P=0.001）and RI （affected hemisphere： P〈0.001; unaffected hemisphere： P〈0.01） in both hemispheres in large- volume group were higher than those in mid-volume and small-volume groups. Vm in both hemispheres decreased gradually within 14 days after onset. Vd in unaffected hemisphere in dead group were lower than that in survival group （P〈0.01）.PI and RI in both hemispheres in dead group were higher than that in survival group （P〈0.01）. Canclusian Aemodynamic parameters of TCD may show the brain blood stream changes of ICH patients and highly predict death in 30 days after onset.