经颅多普勒超声对昏迷病人监测的临床意义

目的观察不同病因、不同程度昏迷病人的经颅多普勒超声（TCD）特点。方法选择62例昏迷病人。记录昏迷原因、生命体征及有关辅助检查资料，同时进行TCD监测，观察频谱形态、颅内血流变化。结果昏迷病人的11CD表现无特征性改变，当出现中度昏迷或深昏迷时，颅内幕上结构损害，颅内幕下结构损害、代谢及弥漫性脑病病人大脑中动脉血流速度改变不明显．但死亡的18例病人中有13例出现了收缩期末血流速低于舒张期末血流速。结论颅内幕下结构损害、代谢及弥漫性脑病病人脑血流变化不明显，中度昏迷及深昏迷病人出现收缩期末血流速低于舒张期末血流速多，提示脑血管自动调节功能丧失、预后不佳。

The Clinical Significance of TCD Monitoring for Patients with Coma

Objective To analyze the TCD characteristics for patients with different causes and different stages of coma.Methods The causes of coma, life signs and data related physical examination were recorded in 62 patients (pts) with coma. The frequency spectrum form and the blood flow velocity in cranial vessels were monitored by TCD.Results There were no characteristic change in pts with semicoma. In pts with moderate or deep coma caused by intracranial uptentorial injury, the TCD manifestations were similar to related documents. There were no obvious change in blood flow velocity of middle cerebral artery in pts with subtentorial brain injury and metabolic or diffused brain diseases. In the 18 dead cases, the blood flow velocity of end systolic stage were lower than that of end diastolic stage in 13 dead pts.Conclusion There were no obvious change in blood flow velocity in pts with subtentorial brain injury and metabolic or diffused brain disease. In the pts with moderate and deep coma, if the blood flow velocity in end of systolic stage was lower than that in the end of diastolic stage, it might suggest that the auto-regulatory function of cerebral blood vessels lose and the prognosis would be bad.