经颅多普勒评价颅缝早闭症手术前后脑血流动力学变化

TCD Evaluate Hemodynamics before and after Surgery in Craniosynostosis

目的:利用经颅多普勒(TCD)技术监测颅缝早闭症患儿手术前后脑血流动力学变化,评价颅缝早闭症手术的减压效果。方法:11例患儿按年龄分3个年龄组:0～3岁组4例;4～7岁组5例;11岁组2例。TCD以双侧大脑中动脉为靶血管,记录患儿手术前后的脑血流速度[收缩峰速度(Vs)和舒张期速度(Vd)]和搏动指数(PI),同时记录血压和脉搏数。结果:0～3岁组,手术后Vs、Vd明显提高(P<0.05),PI明显降低(P>0.05),4例患儿头颅X线平片均见指压纹;4～7岁组,手术后Vs、Vd提高,PI降低(P<0.05);11岁组,手术后Vs、Vd、PI改变不明显(P>0.05)。结论:手术对于改善较小患儿脑血流速度和PI的作用显著;对于稍大患儿舒张期脑血流的改善较收缩期血流明显、PI明显降低。提示手术减压效果明显,TCD可作为非损伤性评价颅狭症手术效果的简便工具。

Aim：To measure hemodynamics of craniosynostosis before and after surgery and evaluate blood flow velocities to determine the operation effect on patients with craniosynostosis by using transcranial Doppler （TCD） ultrasonography.Methods：TCD measurements were routinely performed bilaterally on the middle cerebral artery（MCA） before and after surgery.Peak systolic and diastolic velocities,pulsatility index（PI） were recorded,BP and P being recorded simultaneously.Results：In 0~3 years old group,4 cases＇ Vs and Vd obviously increased（P0.05）,PI obviously decreased（P0.05） after surgery.4 cases＇ skull have embossed plain film X;In 4～7 years old group,5 cases＇ Vs and Vd increased,PI decreased（P0.05） after surgery;In 11 years old group,2 cases＇ Vs,Vd and PI changed not obviously（P0.05）.Conclusion：Surgery was useful for improving brain blood flow velocities and PI in young infants.It was more obvious to improve diastolic velocities than systolic velocities and PI decreased in elder infants.The results clearly demonstrated that TCD may be a useful,non-invasive means of assessing before and after the operation.