经颅多普勒监测蛛网膜下腔出血后脑血管痉挛的临床观察

Discussion on the feasibility of TCD monitoring and diagnosis of intracranial vascular spasm after SAH

目的总结应用经颅多普勒(TCD)监测蛛网膜下腔出血(SAH)后脑血管痉挛的临床价值。方法对2015-06—2016-05本院收治的78例SAH患者进行回顾性分析,均进行TCD监测,同时对患者进行数字减影血管造影(DSA)检查,观察各个时间段患者颅内血管血流速度变化,并以DSA检查结果作为标准判断TCD诊断颅内血管痉挛的价值。结果在7~10d时间段,患者的MCA、ACA、VA、BA血流速度达到峰值,后逐渐下降,颅内血管痉挛现象逐渐缓解;SAH患者MCA、ACA、VA、BA血流速度在<7d、7~10d、10~14d三个时间段比较差异均具有统计学意义(P<0.05);78例SAH患者,TCD诊断发生颅内血管痉挛59例,DSA诊断发生率颅内血管痉挛62例,TCD诊断SAH患者发生颅内血管痉挛的灵敏度为93.55%、特异度为93.75%、漏诊率为6.45%、误诊率为6.25%,TCD诊断颅内血管痉挛与DSA的一致性Kappa=0.816,P<0.05。结论 TCD检查诊断SAH后出现颅内血管痉挛具有准确性高、无创等优点,值得临床推广应用。

Objective To summary clinical value of ranscranial Doppler（TCD）examination in the diagnosis of intracranial vascular spasm after subarachnoid hemorrhage（SAH）.Methods From January 2016 to January 2012 78 patients with SAH admitted to our hospital were retrospectively analyzed and all the patients were performed TCD monitoring and digital subtraction angiography（DSA）,each period in patients with intracranial vascular blood flow velocity changes were observed,and DSA examination results as the standard to judge the value of TCD in the diagnosis of intracranial vascular spasm.Results In 7-10 dtime period,the patient＇s MCA,ACA,VA,BA blood flow velocity reached the peak,then gradually decreased intracranial vascular spasm gradually ease;SAH patients with MCA,ACA,VA,BA blood flow velocity in〈7d,7-10 d,10-14 dthree time periods,the differences were statistically significant（P〈0.05）;78patients with SAH,TCD diagnosis of 59 cases occurred intracranial vascular spasm,by TCD,and 62 cases were diagnosed by DSA.TCD in diagnosis of SAH patients with intracranial vascular spasm,the sensitivity was 93.55%,specificity was 93.75%,misdiagnosis rate was 6.45%,misdiagnosis rate was 6.25%,TCD and DSA in diagnosis of intracranial vasospasm consistency Kappa=0.816,P〈0.05.Conclusion TCD in the diagnosis of cerebral vasospasm after SAH,the advantages of high accuracy and non-invasive,it is worthy of clinical application.