经颅多普勒对外伤性脑血管痉挛的诊断价值

目的 探讨经颅多普勒(TCD)对外伤性脑血管痉挛的诊断价值及外伤性脑梗死的早期预防价值.方法 回顾性分析348例颅脑损伤病人的临床资料,均行TCD监测及CT检查.将TCD诊断为脑血管痉挛的病人按血管痉挛程度分为轻度、中度、重度组,并进行统计学分析.结果 TCD监测发现外伤性脑血管痉挛179例(51.44％),其中轻度组92例,中度组60例,重度组27例;其多在伤后2～3 d出现,持续5～7 d,10～14d后缓解.CT证实发生外伤性脑梗死24例,其中外伤性脑血管痉挛中度组4例,重度组20例;经统计学分析,脑血管痉挛严重程度与外伤性脑梗死的发生存在正相关(P＜0.01);经治疗1个月后GOS预后评分:恢复良好3例,轻度残疾8例,重度残疾7例,死亡6例.结论 TCD诊断外伤性脑血管痉挛安全、无创、有效,对早期预防外伤性脑梗死具有重要临床意义.

Diagnostic value of transcranial Doppler for posttraumatic cerebral vasospasm

Objective To explore diagnostic value of transcranial Doppler （TCD） for the posttraumatic cerebral vasospasm and early preventive value for posttraumatic cerebral infarction. Methods Clinical data of 348 patients with craniocerebral injury was analyzed retrospectively. TCD and CT were preformed in all the patients. The patients with cerebral vasospasm diagnosed by TCD were divided into mild, moderate and severe groups based on the degree ofvasospasm, and analyzed statistically. Results The posttraumatic cerebral vasospasm was found in 179 cases （51.44%） detected by TCD, including 92 in the mild group, 60 in the moderate group and 27 in the severe group, and most occurred 2-3 days after trauma, lasted for 5-7 days and relieved in 10-14 days. The posttraumatic cerebral infarction occurred in 24 cases confirmed by CT, including 4 in the moderate group and 20 in the severe group. By statistical analysis, there was positive correlation between the severity of cerebral vasospasm and the occurrence of traumatic cerebral infarction （P〈0.01）. The GOS scores 1 month after treatment were as follows： good recovery in 3 patients, mild disability in 8, severe disability in 7 and death in 6. Conclusions TCD is a safe, noninvasive and effective method for diagnosis of posttraumatic cerebral vasospasm, and has important clinical significance for prevention ofposttraumatic cerebral infarction.