急性期至稳定期的经颅多普勒超声动态评估在急性重症脑病中的应用研究

目的：评价经颅多普勒超声（ TCD）检测评估急性重症脑病急性期至稳定期的血流动力学动态变化与临床特征及脑功能中的价值。方法我院急性重症脑病患儿30例，在病情急性期和稳定期分别至少行1次TCD检测。应用重复测量资料的多变量分析方法分析双侧大脑中动脉（ MCA）急性期和稳定期的血流动力学参数（收缩期血流速度、搏动指数）的变化趋势和临床特征的关系。比较不同预后组间稳定期和急性期的双侧MCA、大脑前动脉、大脑后动脉血流参数及其差值。结果（1）5例患儿的稳定期TCD血流参数的异常侧与MRI病灶严重侧完全一致。（2）左侧MCA的收缩期血流速度稳定期与急性期的差值绝对值在预后好组为（33.20±30.23）cm／s，预后差组为（71.93±58.21）cm／s，差异有统计学意义（t＝-2.287，P＝0.033）。（3）Glasgow评分和疾病分类是急性期至稳定期TCD血流参数改变的最重要决定因素（P＝0.042、0.005）。（4）急性期与稳定期左侧MCA的收缩期血流速度和搏动指数差异均有统计学意义（ P＝0.002、0.003）。结论 TCD急性期至稳定期的动态评估与临床变化相一致，对于急性重症脑病的脑功能障碍的评估有帮助。

Study on the cerebral hemodynamic changes by transcranial Doppler ultrasonography from emergency ;periods to stable periods in severe acute encephalopathy children

Objective To evaluate the correlations between the cerebral hemodynamic changes of severe acute encephalopathy with the clinical features from emergency periods to stable periods and the value of transcranial Doppler ultrasonography( TCD)in cerebral function assess. Methods Thirty patients with acute brain diseases by assisted mechanical ventilator from Jun 2014 to May 2015 in PICU were included and followed up to Nov 2015,then grouped by Glasgow Coma Scale( GCS),MRI,prognosis( mental sequelae after half a year). Each subject was examined through the temporal bone window by TCD at emergency peri-ods and stable periods. The systolic cerebral blood flow velocity( sCBFV),and pulsatility index( PI)of bilat-eral middle cerebral artery( MCA),anterior cerebral artery,posterior cerebral artery were analyzed. Multivari-ant analysis of variance,repeated measures analysis of variance was conducted to compare sCBFV and PI of MCA among groups in different clinical periods. The variants included sex,disease diagnosis,prognosis, MRI,GCS,and the first abnormal TCD. The variation within groups was tested via a Hotelling T2 test. All sCBFV and PI of each artery and the D-value of sCBFV between the different periods were compared accord-ing to the prognosis groups. Results (1)Five patients could be lateralized,and their lateralization of MRI focus was consistent with the abnormal sides of sCBFV in the stable periods.(2)The D-value of sCBFV in left MCA between the different periods in the poor prognosis group was significantly higher than that in the good prognosis group(71. 93 ± 58. 21)cm/s vs.(33. 20 ± 30. 23)cm/s,t = -2. 287,P =0. 033].(3) Multivariant analysis of variance showed that GCS classification and disease diagnosis were significantly cor-related with the cerebral hemodynamic changes respectively(P =0. 042,0. 005,respectively).(4)sCBFV and PI of left MCA reduced significantly in the stable periods than those in the emergency periods( P =0. 002,0. 003,respectivly). Conclusion The cerebral hemodynamic changes by TCD from emergency peri-ods to stable periods are consistent with the clinical status,dynamic evaluation by TCD may facilitate the evaluation of brain dysfunction in the severe acute encephalopathy.