TCD对行开颅去骨瓣减压术患者的诊疗指导价值

Effect of TCD on severe brain injury patients who accepted decompressive craniectomy

目的:采用经颅多普勒超声(trans-cranial Doppler,TCD)探究行开颅去骨瓣减压术的重度颅脑损伤患者围手术期血流动力学改变与其预后相关性。方法:选取100例于2012年9月至2015年9月入我院神经外科诊治的重度颅脑损伤[格拉斯哥昏迷评分(Glasgow coma scale,GCS)<8分]患者,采用TCD监测患者术前、术后双侧大脑中动脉(middle cerebral artery,MCA)和颈内动脉颅外段(extracranial internal carotid arter y,ICAex)血流动力学参数,并比较差异是否具有统计学意义。结果:相比于术前,患者术后双侧MCA和ICAex平均流速(Vm)显著提高(P<0.01),其中手术侧Vm上升更明显。相比于术前,患者术后搏动指数(pulse index,PI)显著下降,且手术侧下降更为明显。患者术后频谱形态改变为高血流低阻力型。结论:应用TCD能很好地检测行开颅去骨瓣减压术重度颅脑损伤患者围手术期血流动力学改变,且患者颅内血流动力学改变对预后判断具有重要意义。

Objective： Use TCD to explore the perioperative hemodynamic changes and prognosis of patients with severe traumatic brain injury after decompressive craniotomy.Methods： Selected 100 cases with severe traumatic brain injury from September 2012 to September 2015 in our hospital [Glasgow coma scale （GCS） less than 8], and TCD was used to monitor the hemodynamic parameters of bilateral middle cerebral artery （MCA） and extracranial internal carotid artery （ICAex） of both sides in all patients before and atfer operation, then judged whether the difference was signiifcant.Results： Compared to the results before the surgery, the Vm of bilateral MCA and ICAex were signiifcantly increased atfer the surgery （P〈0.01）. And compared to the contralateral side, the Vm of operative side increased more signiifcantly. Compared to the results before the surgery, the PI of bilateral MCA and ICAex decreased signiifcantly atfer the surgery （P〈0.01）, and compared to the contralateral side, the PI of operative side decreased more signiifcantly. And the spectrum of patients atfer operation changed to the type of high blood lfow and low resistance.Conclusion： TCD can play a role in detecting the hemodynamic changes ofpatients with serious traumatic brain injury in perioperative period. And the changes of hemodynamic in patients are signiifcant to the prognosis of the patients.