28例蛛网膜下腔出血患者经颅多普勒超声检查

The Examination to 28 Subarachnoid Hemorrhage Patients

目的:应用经颅多普勒超声(TCD)动态观察蛛网膜下腔出血(SAH)后血流变化情况,预测血管痉挛(VSP)的发生.方法:本文应用TCD动态观察28例SAH患者病后4周内大脑中动脉血流速度(FV)变化,与脑CT显示出血量进行比较,同时观察临床体征的变化.结果:SAH后FV异常率为75%(21/28),VSP的发生率为35.7%(10/28),其中60%(6/10)发生于病后8-12天,持续6～18天;两侧FV明显高于对侧(P<0.01);3例出现症状性VSP患者均为出血量较大者,并于症状出现前1～2天FV每天增加30cm/s以上,平均FV为200cm/s.结论:通过TCD检查可以预测SAH后VSP的发生,其发生率为35.7%,多于病后1～2周内发生; 出血量越多,VSP发生可能性越大;FV大于200cm/s或每大增加超过30cm/s.有发生症状性VSP的倾向.

Objective : To anticipate vasospasm (VSP) after subarachnoid hemorrhage (SAH) through continuous observing the brain blood flow velocity (FV) by using transcranial Doppler (TCD) . Methods: The mean FVs of both middle cerebral arteries of 28 patients with proven SAH were recorded within 4 weeks after the ictues, compared with the volume of blood showed by CT and the clinic symptom. Results: The innormal rate of FV was 75% (21/28) , and the VSP occurrc was 35.7% (10/28) , 60% (6/10) of VSP occurred during 8-12 days after SAH. and last 6-18 days. The affected sides had higher rate of VSP occurrence than trilateral ones (P<) .01) . All of the 3 patients with symptom VSP had more blood in subarachnoid, and their average maximum FVs were over 200cm/s, the increment over 30cm/s per day 1-2 days ahead symptom VSP. Conclusion: It is possible to anticipate VSP after SAH through TCD. The VSP occurrence rate was 35.7% and most of it take place 1-2 weeks after onset. The more blood in subarachnoid, the higher occurrence rate of VSP. There is the tendency to occur symptom VSP when FV is more than 200cm/s or the increment over 30cm/s per day.