TCD对急性脑梗死机械取栓术后脑血流监测应用

Application of TCD in Monitoring Cerebral Blood Flow after Mechanical Thrombectomy for Acute Cerebral Infarction

目的:探讨经颅多普勒超声(TCD)在急性脑梗死(ACI)机械取栓术后脑血流监测中的应用价值。方法:选取2021年6月—2023年8月我院收治的85例ACI患者作为研究对象,均行机械取栓术治疗,治疗7天后采用神经功能缺损评分(NIHSS)评价患者神经功能,依据治疗前后的差值(ΔNIHSS)进行分组,将ΔNIHSS≥4分归为神经功能改善良好组,将ΔNIHSS<4分归为神经功能改善不良组;并随访至治疗后90天,采用改良Rankin评分量表(MRS)评估患者预后,MRS≤2分归为预后良好组,MRS>2分归为预后不良组;并于治疗前及治疗7天后开展TCD检查,明确大脑中动脉舒张末期血流速度(EDV)、收缩期峰值血流速度(PSV)、平均最大血流速度(MV)、搏动指数(PI)变化,并比较治疗前后及不同组别间脑血流参数差异。结果:85例ACI患者治疗后大脑中动脉EDV、PSV、MV高于治疗前,PI低于治疗前,差异有统计学意义(P<0.05);85例ACI患者治疗前NIHSS评分为(12.25±1.52)分,治疗后NIHSS评分为(7.52±1.12)分,ΔNIHSS为(4.73±0.45)分,其中神经功能改善良好组62例,神经功能改善不良组23例;神经功能改善良好组治疗前后大脑中动脉EDV、PSV、MV均高于神经功能改善不良组,PI均低于神经功能改善不良组,差异有统计学意义(P<0.05);85例ACI患者治疗90天MRS评分为(1.89±0.23)分,其中预后良好59例,预后不良26例;预后良好组治疗前后大脑中动脉EDV、PSV、MV均高于预后不良组,PI均低于预后不良组,差异有统计学意义(P<0.05)。结论:TCD在ACI患者机械取栓术后脑血流监测中可评估患者颅脑血流动力学信息,且血流参数与患者神经功能及恢复关系密切,或可作为早期评估患者术后脑血流情况的重要选择之一,为临床治疗提供一定的参考依据。

Objective:To explore the application value of transcranial Doppler ultrasound(TCD)in monitoring cerebral blood flow after mechanical thrombectomy in acute cerebral infarction(ACI).Methods:85 ACI patients admitted to our hospital from June 2021 to August 2023 were selected as the study subjects,all of whom underwent mechanical thrombectomy treatment.After 7 days of treatment,the neurological function of the patients was evaluated using the Neurological Deficiency Scale(NIHSS),based on the difference before and after treatment(ΔNIHSS)will be grouped andΔA score of NIHSS≥4 is classified as a good group for improving neurological functionΔNIHSS<4 points were classified as the group with poor neurological function improvement;Follow up until 90 days after treatment was conducted,and the patient’s prognosis was evaluated using the Modified Rankin Scale(MRS).A score of MRS≤2 was classified as a good prognosis group,while a score of MRS>2 was classified as a poor prognosis group;TCD examination was conducted before and 7 days after treatment to clarify the changes in end diastolic blood flow velocity(EDV),peak systolic blood flow velocity(PSV),mean maximum blood flow velocity(MV),and pulsatile index(PI)of the middle cerebral artery.The differences in cerebral blood flow parameters before and after treatment and between different groups were compared.Results:After treatment,the EDV,PSV,and MV of the middle cerebral artery in 85 ACI patients were higher than before treatment,while the PI was lower than before treatment,with a statistically significant difference(P<0.05).The NIHSS score of 85 ACI patients before treatment was(12.25±1.52)points,and the NIHSS score after treatment was(7.52±1.12)points,ΔThe NIHSS score was(4.73±0.45),with 62 cases in the group with good neurological function improvement and 23 cases in the group with poor neurological function improvement;The EDV,PSV,and MV of the middle cerebral artery in the group with improved neurological function before and after treatment were higher than those in the group with poor neurological function improvement,and the PI was lower than that in the group with poor neurological function improvement,with a statistically significant difference(P<0.05).The MRS score of 85 ACI patients after 90 days of treatment was(1.89±0.23),of which 59 had a good prognosis and 26 had a poor prognosis;The EDV,PSV,and MV of the middle cerebral artery in the group with good prognosis before and after treatment were higher than those in the group with poor prognosis,and the PI was lower than those in the group with poor prognosis,with a statistically significant difference(P<0.05).Conclusion:TCD can evaluate the cerebral hemodynamic information of ACI patients after mechanical thrombectomy in cerebral blood flow monitoring,and the blood flow parameters are closely related to the patient’s neurological function and recovery.It may be an important choice for early evaluation of postoperative cerebral blood flow in patients,providing a certain reference basis for clinical treatment.