颅脑超声在去骨瓣减压术后重症患者评估中的应用

Applications of transcranial ultrasound in the postsurgical evaluation of critically ill patients underwent decompressive craniectomy

目的分析因颅内血肿行去骨瓣减压术的重症患者术后颅脑超声评价结果,并与术后常规监测和颅脑CT结果进行比较。方法选择2014年9月至2014年11月我科收治的因颅内血肿形成接受开颅去骨瓣减压术并保留骨窗的患者,术后第1天行头颅CT检查,入室时和CT扫描前行经骨窗颅脑超声检查,评估病变类型,包括中线结构移位、颅内出血、脑室改变和硬膜下积液等。结果共纳入患者25例。颅脑CT总计发现病情变化18个,超声检查发现病情改变13个,检出率72.2%。术后迟发颅内事件头颅CT总计发现8例,超声检查发现7例,检出率87.5%。漏检原因包括硬膜下积气和枕叶深部病变。结论经骨窗颅脑超声检查能够有效地对去骨瓣减压术后患者进行颅内影像学评估,且与头颅CT的变化有很好的一致性。颅脑超声的动态变化能够提示术后迟发颅内事件。

Objective The aims of this study were to access the application of transcranial sonography in the critically ill patients who underwent decompressive craniectomy due to brain hematoma and to determine the agreement between transcranial sonography and cranial computed tomography（CT）.Method Patients who had intracranial hematoma and underwent decompressive craniectomy with retained bone window were studied.On postoperative Day 1 after decompressive craniectomy,crainial CT was performed.Patients also received transcranial sonography before CT scan and at the time of entering intense care unit to evaluation variable types of lesions,which include dislocation of midline structures,intracranial hemorrhage,deformation of the ventricular system and subdural fluid collection.Result Twentyfive patients were enrolled in study.Ultrasound examination was able to revealed 13 lesions while CT detected 18 lesions.The detection rate of ultrasound vs CT scan was 72.2%.For postsurgical delayed intracranial events,ultrasound examination found 7 cases while CT indicated 8 cases in total.The detection rate of transcranial ultrasound was 87.5%.The reason of a false-negative finding in ultrasound included intracranial subdural gas accumulation and deep location,such as lesions in occipital lobe.Conclusion Transcranial ultrasound imaging through the craniotomy could effectively evaluate patients underwent decompressive craniectomy and was highly consistent with cranial CT scan.As a valid continuous monitoring method,transcranial ultrasound could indicate postsurgical delayed intracranial events.