脑动静脉畸形栓塞术中血流动力学监护及意义

目的　用经颅多普勒（ＴＣＤ） 进行监护，了解脑动静脉畸形（ＡＶＭ）供血状况及其变化。方法　ＡＶＭ 患者１１ 例，均经股动脉穿刺插管后行栓塞治疗。分别于栓塞前、中、后全程动态监护ＡＶＭ 血流状态变化。以大脑前、中、后动脉血流速度（ＢＦＶ）和脉动指数（ＰＩ） 为观察指标。结果　１１ 例中有１０ 例显示明显的ＴＣＤ变化。ＡＶＭ 体积越大，血流量越大，流速增高，ＰＩ下降。频谱形态变化明显。栓塞后，供血动脉主干流速下降，ＰＩ升高，其测量值与栓塞前比较有统计学意义（Ｐ＜ ０－０５），频谱形态趋于恢复。结论　ＴＣＤ 可敏感地反映ＡＶＭ 栓塞过程中血流状态变化，对了解栓塞程度具有重要意义。

Study of Hemodynamics Monitoring and Significance in the Embolization of Arteriovenous Malformation

Objective Transcranial Doppler (TCD) monitoring is to detect the status and change of main blood supply of cerebral arteriovenous malformation (AVM).Methods 11 cases of AVM were embolized by puncturing and intubating to the femoral artery.The blood flow of these cases were continually monitored in 3 stages:peri ,mid and post of embolization.The blood flow velocity (BFV) and pulsed index (PI) were observed in anterior cerebral artery (ACA),middle cerebral artery (MCA) and posterior cerebral artery (PCA).Results 10 of 11 cases had obvious changes of TCD.The larger of AVM,the more amount of blood flow.When BFV increased,PI decreased.The spectrum changed dramatically.After embolization,BFV reduced and PI raised.The spectrum gradually restored to normal.There was a significant difference before and after embolization.Conclusion TCD could show the status of blood flow sensitively during embolization which indicated the degree of embolizing.