经颅多普勒对蛛网膜下腔出血导致血管痉挛的临床研究

Study on transcranial doppler in cerebral vasospasm caused by subarachnoid hemorrhage

目的研究实时床旁经颅多普勒(transcranial doppler,TCD)在蛛网膜下腔出血(subarachnoid hemorrhage,SAH)中对脑血管痉挛(cerebral vasospasm,CVS)的预警和治疗指导作用。方法采用前瞻性研究TCD实时监测180例CT确诊SAH患者大脑中动脉(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)和血流频谱,自身健侧作为正常对照,对符合CVS诊断标准的使用尼莫地平进行治疗,观察疗效。结果与健侧相比,出血侧PI、RI增大,Vd、Vm减小,其中以Vd减小较明显,与健侧相比有显著差异意义(P<0.01),Vs与健侧相比无显著差异(P>0.05);CVS组与非CVS组相比Vm明显增加,差异有统计学意义(P<0.001)。监测SAH后出现血管痉挛52例(28.89%),经尼莫地平治疗均获得缓解。结论采用TCD监测SAH患者脑血流变化,其对血流的监测为临床诊断和个性化治疗SAH后CVS提供参考依据,经TCD的预警和干预明显提高了SAH的疗效。

Objective To study the real-time and bedside application of transcranial Doppler （TCD） in the cerebral vaso-spasm （CVS） caused by subarachnoid hemorrhage （SAH） .Methods TCD was applied to detect the mean blood velocity （Vm） ,pulsatility index （PI） ,resistance index （RI） and blood flow spectrum of the middle cerebral artery （MCA） in the 180 patients with SAH diagnosed by Computed Tomography scan ,with control of self-healthy side .According to the detection of CVS ,Nimodipine was used to control the vasospasm and the results were recorded and analyzed .Results Compared bleeding side with healthy side ,the data of TCD show that PI and RI were increased ,and Vd and Vm were decreased ,in which there were statistical significance in PI ,RI ,Vd and Vm （P〈0 .01） .And there were no statistical significance in Vs （P〉0 .05） . There were statistical differences in Vm between CVS group and non-CVS group （P〈0 .001） .All the 52 cases （28 .89% ） with vasospasm detected by TCD were all relieved by the treatment of Nimodipine .Conclusion The parameters of TCD could reflect the changes of brain blood flow and ICP ,which may be helpful for the diagnosis and treatment of SAH .And it is also helpful for the personalized treatment of CVS detected by TCD after SAH .