基于卒中登记的颅内动脉瘤致蛛网膜下腔出血的临床研究

Clinical Research on Aneurysmal Subarachnoid Hemorrhage Based on Stroke Registry

目的:研究基于卒中登记的颅内动脉瘤致蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,a SAH)的颅脑血流动力学改变及其对诊断治疗的指导作用。方法:采用回顾性研究经卒中登记系统筛选出48例经DSA(digital subtraction angiography,DSA)确诊的a SAH,收集患者床旁经颅多普勒(transcranial Doppler,TCD)监测大脑中动脉(middle cerebral artery,MCA)的动脉平均峰值流速(mean blood velocity,Vm)、搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI),自身健侧作为正常对照,均采用血管内介入治疗,对其中符合脑血管痉挛(cerebral vasospasm,CVS)诊断标准的患者使用尼莫地平进行治疗,观察疗效。结果:与健侧相比,患侧PI、RI增大,Vd、Vm减小,其中以Vd减小较明显,与健侧相比有统计学差异(P<0.01),Vs与健侧相比无统计学差异(P>0.05)。CVS组与非CVS组相比Vm明显增加,有统计学差异(P<0.001)。所有患者经水膨胀弹簧圈或支架预后均得到改善。结论:床旁实时TCD监测能反映a SAH脑血流变化,对CVS进行及时解除痉挛治疗,并为介入治疗提供参考依据,颅脑血流实时监测和介入治疗综合运用提高了a SAH患者的治疗效果。

Objective： To study the brain blood flow change and its benefit for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage（a SAH） based on stroke registry. Methods： A retrospective single center method based on stroke registry was applied in this study and 48 patients＇ clinical data with a SAH diagnosed by digital subtraction angiography（DSA） were registered, which contained transcranial Doppler（TCD） parameters including the mean blood velocity（Vm）, pulsatility index（PI）, and resistance index（RI） of the middle cerebral artery（MCA）, with a control of self healthy side. All patients were treated with interventional therapy and the results were collected and analyzed, in which there were some cerebral vasospasm（CVS） detected and treated with Nimodipine. Results：The data of TCD show that PI and RI were increased, and Vd and Vm decreased, in which there were statistical significance in PI, RI, Vd and Vm between ill side and healthy side（P0.01）. And there were no statistical significance in Vs（P0.05）. There were statistical differences in Vm between CVS group and non CVS group, P0.001. All the patients were relieved by interventional therapy with the water expansion spring coil or stents. Conclusion： The parameters of TCD could reflect the changes of brain blood flow, which were helpful for the diagnosis and treatment of a SAH. And it is also helpful for the personalized treatment of CVS detected by TCD and for the decrease of lethality and disability of a SAH.