出血性脑卒中的经颅多普勒动态观察

DYNAMIC OBSERVATION ON TRANSCRANIAL DOPPLER IN HEMORRHAGIC STROKE

目的:探讨出血性脑卒中后脑血流动力学的动态改变。方法:回顾48例出血性脑卒中患者病后48小时内至病后4周的经颅多普勒(TCD)动态观察资料,以大脑中动脉(MCA)的平均血流速度(Vm)及脉动指数(PI)为指标进行分析。结果:本组23例蛛网膜下腔出血(SAH)患者中有15例迟发性缺血性神经功能障碍(DINDS)侧MCA的Vm与PI呈进行性增高,有8例DINDS侧MCA的PI进行性增高伴Vm进行性减慢;并与对侧有显著差异,且早于DINDS临床症状出现。25例脑出血患者两侧MCA均有Vm降低、PI增高改变,但以血肿侧更为显著;病程中以病后1周左右上述改变最为显著,病后4周左右恢复至病初水平。结论:1、SAH继发迟发性缺血性神经功能障碍(DINDS)时可见PI增高伴Vm增高或减低的改变早于临床症状出现,且与临床有良好的相关性。2、TCD可通过对脑底动脉流速、阻力指数的观察,对脑出血后血肿占位效应和由此引起的脑组织缺血水肿发生、演变及严重程度进行判断。

Objective: To study the hemodynamic change of celebral arteria after hemorrhagic stroke. Methods: The hemodynamic change of 48 cases of hemorrhagic stroke were studied retrospectively by TCD. Mean volosity of blood flow( Vm) and pulsatility index (PI) of middle cerebral artery (MCA) in 48 hours - 4 weeks ware analysed. Results:In the 23 cases with subarachnoid hemorrhage(SAH) , the Vm and puisatility index(PI) of ip-silateral side of delayed ischemic neurological dysfunction(DIND) increased progressively in 15 cases than that of contralateral side and showed early than the clinical manifestation (P < 0.01) , the PI of ipsilateral side of DIND was increased progressively than that of contralateral side while the Vm was decreased progressively than that of contralateral side in 8 cases, and showed early than the clinical manifestation (P < 0.01) . In the 25 cases with in-tracerebral hemorrhage (ICH) , the Vm of MCA in bothside was decreased, but the PI was increased ,and the hemorrhage side varied more obviously. The hemodynamic change varied significantly at 1 week and restored at 4 week. Conclusion: The TCD change of delayed creabral vasospsm(DCVS) after SAH shows that Vm and PI increased in former while the PI increased with lower Vm in latter,both change were earlier than the clinical manifestation and have significant relation. Through Vm and PI in base cranial arterias, TCD can observe variation and severity of the bleeding and mass effect of hematoma and edema result from ischemia.