经颅多普勒在脑积水中的价值

目的 本次研究是为明确脑积水患者经颅多普勒(TCD)监测结果与患者颅内压之间的关系.方法 选择32例行脑室腹腔分流术的脑积水患者纳入患者组,在术中行分流前测定患者颅内压,在术前1d和术后5d分别行大脑中动脉( MC As)的TCD监测；选择27例门诊体检健康个体为对照组,行大脑中动脉TCD监测,监测结果作为正常参考值.结果 患者组行分流术前TCD监测脑血流速度(CBFV)提示平均血流速度、收缩期血流速度和舒张期血流速度明显低于对照组；搏动指数(PI)和阻抗指数(RI)明显高于对照组.RI与脑积水患者颅内压呈正相关(r=0.701,P＜0.01)；PI与脑积水患者颅内压呈相关性(r =0.426,P=0.015).脑积水患者分流术后颅内压降到正常水平,PI和RI值下降,脑血流速度上升.有1例患者术后第9天出现颅内压增高表现,复查CT提示脑室尺寸扩大,TCD检查出现脑血流下降,PI和RI值升高,急诊行脑室腹腔分流再通术后复查CT及TCD,结果均恢复至正常.结论 经颅多普勒可作为评价脑积水患者颅内高压的有效手段,RI和PI值是判断颅内压升高的有效指征.

The transcranial doppler findings in patients with hydrocephalus

Objective To investigate a possible relationship between Trancranial Doppler(TCD) parameters and intracranial pressure(ICP) changes in adult patients with hypertensive hydrocephalus.Methods Blood flow velocity in the middle cerebral artery(MCA) was studied by TCD in 32 hydrocephalus patients 1 day before shunting and 5 days after operations,and 27 healthy controls were taken in as reference.ICP was measured in the patient group before ventricular shunting and was correlated with TCD data.Results The mean cerebral blood flow velocity(CBFV) in hydrocephalic patients prior to ventriculoperitoneal shunting was significantly lower than in the control group.Compared to normal persons,systolic and end-diastolic CBFV values in patients were significantly decreased.Pulsitility index(PI) and resistant index(RI) values in patients with elevated ICP prior to shunting were significantly increased in comparison to those of normal persons.There was a statistically significant positive correlation of preshunting ICP and mean preshunting values of RI(r=0.701,P<0.01),and significant correlation between PI and ICP(r=0.426,P=0.015)in hydrocephalic patients.Immediately after shunting,ICP returned to normal,and PI and RI values decreased significantly,while the mean CBFV increased.In 1 patient subsequent hydrocephalic symptom was accompanied by appropriate changes in TCD parameters and CT 9 days after operation,which reversed after successful shunt revision.Conclusion TCD may provide a tool for assessment of ICP in adult patients with occlusive hydrocephalus.Changes in the RI and PI indices appear to be useful indicators of elevated ICP.