经颅多普勒对脑动脉瘤夹闭术后迟发性脑缺血的早期预测分析

The Early Prediction of Delayed Cerebral Ischemia after Cerebral Aneurysm Clipping with Transcranial Doppler

目的:分析经颅多普勒对脑动脉瘤夹闭术后迟发性脑缺血的早期预测效果。方法:回顾性分析阳江市中医医院及协作单位广东三九脑科医院2014年7月至2016年6月因a SAH在神经外科接受动脉瘤夹闭术治疗后早期TCD监测的82例患者临床资料,均行经颅多普勒检测,用受检者工作曲线分析TCD预测迟发性脑缺血情况,并对迟发性脑缺血危险因素进行Logistic多元回归分析。结果:本组术后发生DCI有26例(37.71%),大脑中动脉平均血流速=160 cm/s时预测迟发性脑缺血的准确率最高,敏感性、特异性分别为93.64%、46.57%。Logistic多元回归分析显示:迟发性脑缺血与大脑中动脉平均血流速≥160 cm/s、改良Fisher分级具显著相关性。结论经颅多普勒可提高动脉瘤夹闭术后迟发性脑缺血的早期预测准确性,且影响迟发性脑缺血的危险因素主要是大脑中动脉平均血流速≥160 cm/s、改良Fisher分级。

Objective To analyze the early predictive effect of transcranial Doppler （TCD） on delayed cerebral ischemia after cerebral artery occlusion. Methods A retrospective analysis of the clinical data of 82 patients with aSAH during the early TCD monitoring of aSAH after aneurysm clipping was performed retrospectively from July, 2014 to June, 2016 in our hospital and Guangdong Sanjiao Brain Hospital. All patients underwent transcranial Doppler detection, TCD was used to predict the delayed cerebral ischemia, and the delayed cerebral ischemia was detected by TCD. Blood risk factors were analyzed by Logistic multiple regression analysis. Results The accuracy rate of delayed cerebral ischemia was 26 cases （37.71%）, and the average blood flow velocity of middle cerebral artery was 160cm / s. The sensitivity and specificity were 93.64 %, 46.57 %; Logistic multivariate regression analysis showed that delayed cerebral ischemia had a significant correlation with the average blood flow velocity of the middle cerebral artery ≥ 160 cm / s and improved Fisher＇s classification. Conclusion Transcranial Doppler could improve the early prediction accuracy of delayed cerebral ischemia after aneurysm clipping, and the main risk factors of delayed cerebral ischemia were the average blood flow velocity of middle cerebral artery ≥ 160cm / s, Improved Fisher classification.