创伤性脑损伤与自发性蛛网膜下腔出血所致脑血管痉挛的TCD临床对比观察

目的探讨经颅多普勒超声（TCD）对创伤性脑损伤（TBI）及自发性蛛网膜下腔出血（SAH）所致脑血管痉挛（CVS）的诊断价值。方法选择381例TBI和216例SAH患者,应用CT、CTA及TCD等确定患者的临床诊断并筛选出存在CVS者,对TCD发现的CVS患者按血管痉挛程度（VmMCA值）分为轻、中、重三组。每天1次行TCD监测。比较两组CVS发生率、开始时间、严重程度及持续时间。结果 381例TBI患者中共发生CVS 210例,发生率为55.12%;CVS发生在伤后2~3 d,持续10~14 d。而216例SAH患者CVS发生151例,发生率为69.91%,发生时间在发病后3~7 d,持续14~21 d。两组CVS发生率、发病高峰及病程比较差异均有统计学意义（P〈0.01）。结论 TCD对CVS能准确进行临床诊断;创伤性脑损伤所致脑血管痉挛发生率低于自发性蛛网膜下腔出血脑血管痉挛,但发生时间早,发生程度轻,持续时间短,预后好。

Comparative study on the dinicai effect of transcranial Doppler sonography in the diagnosis of cerebral vasospasm caused by traumatic brain injuries and spontaneous subarachnoid hemorrhage.

Objective To assess the clinical effect oftranscranial Doppler sonography （TCD） in the diagno- sis of cerebral vasospasm （CVS） caused by traumatic brain injuries （TBI） or spontaneous subarachnoid hemorrhage （SAH）. Methods Firstly, we did clinical diagnosis and screened out the patients of CVS from 381 patients of TBI and 216 patients of SAH by application of CT, CTA, TCD, which were divided into three groups by degree of CVS （value of VmMCA）： mild group, moderate group and severe group. Secondly, all the patients of CVS were checked with TCD once a day. At last, the dates of incidence, severity, beginning and duration time, was to deal by means of analysis and contrast in the patients of CVS between the patients of TBI and those of SAH. Results A total of 210 patients developed cerebral vasospasm in the 381 patients of TBI, with the incidence of 55.12%. The cerebral vaso- spasm generated principally at the time of posttranmatic 2 to 3 day, and lasted 10 to 14 days. Meanwhile, 151 patients developed CVS in the 210 patients of SAH, with the incidence of 69.3%. The cerebral vasospasm generated 3 to 7 days after disease, lasted 14 to 21 days. There were significant differences between pick and course of CVS in the pa- tients of TBI and those of SAH （P〈0.01）. Conclusion To use TCD to diagnose cerebral vasospasm is accurate. The CVS in patients of TBI happens earlier, with less degree and shorter duration, compared with the patients of SAH.