动脉瘤性蛛网膜下腔出血患者的脑血流动力学分析

目的探讨经颅多普勒(TCD)检测动脉瘤性蛛网膜下腔出血(SAH)患者脑血流动力学改变的临床意义。方法 35例CT检查为SAH患者,均行CTA和(或)DSA检查证实为动脉瘤并行动脉瘤夹闭术。于SAH后各时间段行TCD检测,动态检测大脑中动脉平均血流速度(MCAVm)、阻力指数(RI)等血流动力学参数,计算同侧大脑中动脉与颅外段颈内动脉之比(LI)指数,分析血流频谱形态等脑血流动力学改变,并且与SAH后7-10dCTA检测结果进行对比分析。结果TCD检测显示,MCA Vm、LI指数于动脉瘤性SAH后3-6d开始升高,7-9d达高峰,持续至13-16d;以MCA Vm高于120cm/s及LI指数>3作为判断脑血管痉挛(CVS)的标准,CVS发生率51.4%(18/35),且TCD与CTA检测结果有良好的一致性(Kappa=0.727)。结论 TCD是判断动脉瘤性SAH后CVS的一项无创的检查手段,具有操作简便、可重复检测等优势。

The analysis of cerebral hemodynamics in patients with aneurysmal subarachnoid hemorrhage

Objective To study the clinical value of hemodynamic changes in cerebral circulation detected by transcranial Doppler(TCD) in the patients with aneurysm subarachnoid hemorrhage(SAH).Methods SAH in 35 patients was confirmed by CTA and/or DSA,who were operated for aneurysm clipping and underwent periodic TCD monitoring.The changes of mean flow velocities in the middle cerebral artery(MCA Vm) were record and Lindegaard index(LI) was calculated.The hemodynamic changes of cerebral circulation were analyzed and the onset of cerebral vasospasm(CVS) detected by TCD with CTA during 7-10 days after aneurysm SAH was compared.Results MCA Vm and LI usually increased during 3-6 days,peaked in 7-9 days and lasted until 13-16 days after aneurysm SAH.Taking MCA Vm>120 cm/s and LI>3 as the criteria for CVS,the incidence rate of CVS was 51.4%.The results of TCD were well accordant to those of CTA(Kappa=0.727).Conclusion TCD is a noninvasive method for detecting CVS after aneurysm SAH with an advantage of simple and repeated examination.