TCD参数与重型颅脑损伤患者颅内压及脑灌注压的相关性研究

目的：探讨重型颅脑损伤患者经颅多普勒（transcranial doppler,TCD）参数与颅内压（intracranial pressure,ICP）及脑灌注压（cerebral perfusion pressure,CPP）的关系。方法:应用TCD检测40例重型颅脑损伤患者入院后连续7?d的大脑中动脉收缩期峰血流速度（peak systolic velocity,Vs）、舒张期末血流速度（end diastolic velocity,Vd）、平均血流速度（mean velocity,Vm）以及搏动指数（pulsatility index,PI）、阻力指数（resistance index,RI），同时记录ICP、CPP、平均动脉压（mean arterial pressure,MAP）。结果:ICP与Vs、Vd、Vm均呈负直线回归关系，ICP与RI呈正直线回归关系，而与PI呈正指数回归关系。CPP与Vs、Vd、Vm均呈正直线回归关系，CPP与RI呈负直线回归关系，而与PI呈负指数回归关系。其中PI的相关系数最大 (rICP=0.809,rCPP=-0.828，P＜0.001)。在20?mmHg≤ICP≤50?mmHg、40?mmHg≤CPP≤70?mmHg范围内，PI与ICP、CPP也呈直线相关，且相关性更好(rICP=0.864,rCPP=-0.887，P＜0.001)。结论:TCD参数能够定性或半定量地判断ICP和CPP的变化，应用TCD是无创监测ICP和CPP的方向。

A relativity study on TCD ultrasonography parameters with intracranial pressure and cerebral perfusion pressure in patients with severe brain injury

To study whether the transcranial doppler(TCD) ultrasonography parameters relate to the intracranial pressure(ICP) and the cerebral perfusion pressure(CPP) in severe brain injury patients. Methods： In consecutive 7 days, the peak systolic velocity (Vs), end diastolic velocity (Vd),mean velocity (Vm), resistance index (Ri)and pulsatility index (Pi) of the middle cerebral artery were determined by TCD ultrasonography in 40 patients with severe brain injury. The ICP, CPP and MAP were also determined. Results： There were inverse linear relationships between ICP and Vs, Vd, Vm, linear relationship between ICP and Ri, and exponential relationship between ICP and Pi. There were linear relationships between CPP and Vs, Vd, Vm, inversely linear relationship between CPP and Ri and inverse exponential relationship between CPP and Pi. prominent (rICP=0.809,　rCPP=-0.828 P＜0.001). In the context of 20?mmHg≤ICP≤50 mmHg and 40?mmHg≤CPP≤70?mmHg, ICP and CPP with Pi was also straightly related, and the relativity was better(rICP=0.864,rCPP=-0.887 P＜0.001). Conclusion： It is helpful by using TCD parameters in evaluating ICP and CPP qualitively and quantatively. It is promising to monitor the ICP and CPP noninvasively by studying parameters of TCD.