经颅多普勒监测和尼膜同对脑外伤后脑血管痉挛的作用

Roles of transcranial Doppler monitoring and Nimotop in treatment of posttraumatic cerebral vasospasm

目的 分析脑外伤后脑血管痉挛 (CVS)的发生规律及经颅多普勒 (TCD)监测CVS的作用 ,并评价尼膜同对脑外伤后CVS的治疗价值。 方法 将 72例脑外伤后CVS患者分为治疗组 (尼膜同治疗组 30例 )和对照组 (42例 ) ,分别于伤后第 1,3,7,14天通过TCD对双侧大脑中动脉 (MCA)及颈内动脉 (ICA)颅外段进行脑血流速度监测 ,并评价其意识情况和预后 ,分析尼膜同对脑外伤后CVS患者预后的影响。 结果 伤后 1～ 3d已开始出现血管痉挛 ,3～ 7d达峰值 ,14d时明显减轻 ;治疗组血管痉挛的程度明显低于对照组 (P <0 .0 5 ) ,并且其意识情况和预后均明显好于对照组 (P <0 .0 5 ) ;血管痉挛程度越重 ,病情越重 ,预后越差。 结论 TCD是监测脑外伤后早期CVS的有效方法 ,尼膜同对纠正脑外伤后CVS有显著疗效。

Objective To analyze the incidence law of cerebral vasospasm (CVS) and the role of transcranial doppler (TCD) in detecting CVS and evaluate the value of Nimotop in treatment of CVS . Methods A total of 72 patients with posttraumatic CVS were divided into two groups ,control group (n =4 2 )and treatment group (n =30 ,treated with Nimotop) .The cerebral blood flow velocities of bilateral MCA and extracranial portion of ICA were monitored regularly by TCD 1,3,7 and 14 days respectively after treatment.Effect of Nimotop on the prognosis and consciousness of CVS patients was evaluated according to GCS ,GOS and hemodynamic changes. Results Cerebral vasospasm occurred at days 1 3,reached the peak at days 3 7 and the nmarkedly relieved at day 14 after injury .CVS in the treatment group was significantly better (P <0 .0 5 )with better consciousness and prognosis (P<0 .05) than that in the control group .Severer CVS and diseases would beget poorer prognosis. Conclusions Early posttraumatic CVS can be detected effectively by TCD and Nimotopis effective in treatment of posttraumatic CVS .