脑脊液外引流或颅内血肿清除的经颅多普勒观察

为了有效地改善颅内压增高患者的脑血流（ＣＢＦ），对３１例急性脑外伤患者实施了经颅多普勒（ＴＣＤ）超声监测。其中１８例用脑脊液（ＣＳＦ）外引流治疗，１３例行颅内血肿血肿清除术。观察指标为：大脑中动脉血流速度（ＭＣＡＶ），脉动指数（ＰＩ）和舒张期末流速（Ｖｄ）。结果发现，每引流出１ｍｌＣＳＦ时，其中平均流速（ＴＡＭ），Ｖｄ升高，ＰＩ下降。当ＣＳＦ引流５～６ｍｌ时，上述改变更为明显（Ｐ＜０．０１）。但当ＣＳＦ超过６ｍｌ，则血流速度没有进一步变化（Ｐ＞０．０５）。开始清除颅内血肿时，ＴＡＭ，Ｖｄ和ＰＩ无变化（Ｐ＞０．０５）。当血肿清除体积达５０％时，ＴＡＭ和Ｖｄ上升，ＰＩ下降，具有统计学意义（Ｐ＜０．０５）。提示：通过脑室引流管排放ＣＳＦ可迅速地改善ＭＣＡＶ。颅内血肿清除的早期对血流改善影响不大。清除血肿宜彻底，至少应清除５０％体积以上。

A transcranial Doppler study of drainage of cerebrospinal fluid and intracranial hematomas

To improve cerebral blood flow(CBF) more effectively in patients with raised intracranial pressure(ICP), transcranial Doppler(TCD)monitoring was performed. TCD monitoring was carried out on 31 patients with raised ICP.The time averaged mean(TAM),the pulsatility index(PI) and the end-diastolic velocity(Vd) of middle cerebral artery velocity(MCAV) were analyzed during the process of drainage of CSF and hematomas.Drainage was performed drop by drop through a ventricular catheter on 18 of the 31 patients in which external ventricular drainage collection system provided connection with a pressure transducer.Removal of intracranial hematomas was performed intricately through a subarachnoid screw on 13 of the 31 patients. The increase of TAM and Vd and the decrease of PI had a statistical significance(P<0.05)when l milliliter(ML) CSF was drained. The changes became more significant(P<0.01 )on drainage of 5-6ml CSF. When the CSF was drained more than 6 ml,the changes of TAM ,Vd and PI had no statistical significance(P>0.05). On the initial drainage of hematomas ,the changes of TAM, Vd and PI were not significant (P>0.05). When nearly 50% of the volume of the hematomas was removed ,a statistically significant increase in TAM and Vd and a decrease in PI were observed(P>0.05). Removal of CSF through a ventricular catheter can rapidly improve MCAV. To improve CBF more effectively in patients with intracranial hematomas,at least half of a hematoma should be removed.