TCD监测自发性脑出血患者的脑血流变化

Hemodynamic TCD monitoring on spontaneous intracerebral hemorrhage patients

目的探讨应用TCD和颅内压监测自发性脑出血患者采用小骨窗开颅血肿清除术与大骨瓣开颅血肿清除术前、后手术侧与对侧脑血流动力学变化及其颅内压变化,及其与患者预后关联性。方法对我院神经外科于2016年1月至2017年3月收治的自发性脑出血患者64例,采用小骨窗开颅血肿清除术与大骨瓣开颅血肿清除术,应用TCD检测术前和术后患者双侧大脑中动脉(MCA)及颈内动脉颅外段(ICAex)血流动力学参数,比较术前、术后差异是否有统计学意义,同时监测术后血肿侧的颅内压。结果术前相比,术后患者双侧MCA及ICAex平均流速(Vm)明显增快(P<0.05),且术侧Vm增快更为显著。与术前相比,搏动指数(PI)术后明显降低,其中术侧降低更显著。患者频谱形态术后转为高血流低阻力型,小骨窗开颅血肿清除术与大骨瓣开颅血肿清除术两组间血流变化没有显著差异,血肿侧颅内压随时间变化呈逐渐下降趋势,与脑血流变化有密切关系。结论采用TCD和颅内压监测能很好地检测自发性脑出血患者围手术期血流动力学改变,小骨窗与大骨瓣对脑血流的变化影响不大。

Objective To explore the perioperative hemodynamic changes of patients with spontaneous intracerebral hemorrhage by TCD monitoring between small bone window and big craniotomy with bone falp. Methods 64 cases with spontaneous intracerebral hemorrhage pa- tients from January 2016 to March 2017 in our hospital treated by small bone window and big cra- niotomy with bone falp, and TCD was used to monitor the hemodynamic parameters of bilateral middle cerebral artery （MCA） andextracranial internal carotid artery （ICAex） of both sides in all patients before and after operation. Results Compared to the results before the surgery,the Vm of bilateralMCA and ICAex were significantly increased after the surgery （P〈0. 05）. And com- pared to the contralateral side, the Vm of operative side increased more significantly. Compared to the results before the surgery, the PI of bilateral MCA and ICAex decreased significantly after the surgery （P〈0.05）, and compared to the contralateral side, the PIof operative side decreased more significantly. And the spectrum of patients after operation changed to the type of high blood flow and low resistance. Conclusion TCD can play a role in detecting the hemodynamic changes of pa- tients with spontaneous intracerebral hemorrhage,but there are no difference between small bone window and big craniotomy with bone falp.