经颅彩色多普勒超声在脓毒症相关性脑病患者脑血流评估中的应用

Application of transcranial color Doppler ultrasonography in evaluation of cerebral blood flow in patients with sepsis-associated encephalopathy

目的探讨经颅彩色多普勒超声检测在脓毒症相关性脑病患者脑血流评估中的应用价值。方法根据重症监护病房谵妄评估表结果将48例脓毒症患者分为脓毒症脑病组(29例)和非脑病组(19例)。患者均在入院第1天与第3天进行经颅彩色多普勒超声检查,比较两组患者大脑中动脉血流峰值速度(Vs)、舒张期流速(Vd)、平均血流速度(Vm)和搏动指数的变化。结果入院第1天,相较于非脑病组,脓毒症脑病组患者的Vs、Vm、搏动指数值升高,Vd降低(均P<0.05)。入院第3天,脓毒症脑病组患者的Vs、Vm、搏动指数值均较入院第1天降低,Vd较入院第1天升高(均P<0.05);非脑病组患者的Vs、Vm、Vd、搏动指数值与入院第1天时比较,差异无统计学意义(P>0.05)。结论脓毒症患者早期脑血流速度及搏动指数值改变可能与脓毒症脑病的发病相关。经颅彩色多普勒超声可动态获得各项脑血流指标,更早地发现脓毒症患者的脑血流变化,是评估脓毒症患者脑血流动力学的重要方法,有利于指导脓毒症脑病的临床诊疗。

Objective To explore the application value of transcranial color Doppler ultrasonography in the evaluation of cerebral blood flow in patients with sepsis-associated encephalopathy(SAE).Methods Forty-eight patients with sepsis were divided into SAE group(29 cases)and non-encephalopathy group(19 cases)according to the results of the Intensive Care Delirium Screening Checklist.All the patients were examined by transcranial color Doppler ultrasonography on the first and third day of admission.Changes in peak cerebral artery flow velocity(Vs),diastolic velocity(Vd),mean blood flow velocity(Vm),and pulsatility index were compared between the two groups.Results On the first day of admission,Vs,Vm,and pulsatility index were increased and Vd was decreased in the SAE group than in the non-encephalopathy group(all P<0.05).On the third day of admission,Vs,Vm and pulsatility index were decreased and Vd was increased in the SAE group as compared with those on the first day of admission(all P<0.05);in the non-encephalopathy group Vs,Vm,Vd and pulsatility index on the third day of admission did not statistically differ from those on the first day of admission(P>0.05).Conclusion Early changes of cerebral blood flow velocity and pulsatility index in septic patients may be related to the pathogenesis of SAE.Transcranial color Doppler ultrasonography can dynamically obtain various cerebral blood flow indicators and detect the changes of cerebral blood flow in patients with sepsis earlier,which is an important method for evaluating cerebral hemodynamics in septic patients and is beneficial to guide the clinical diagnosis and treatment of SAE.