血流动力学动态监测在外伤性蛛网膜下腔出血中的应用

目的探讨脑外伤性蛛网膜下腔出血后血管痉挛引起的血流动力学改变的发生、发展规律及对预后的影响，为临床预防和治疗脑外伤性蛛网膜下腔出血后血管痉挛选择方法及治疗时间窗提供一种新的可靠的检测指标；方法采用经颅多普勒技术对98例脑外伤后蛛网膜下腔出血患者的血流动力学状态进行了动态观察，同时对经颅多普勒在脑外伤后蛛网膜下腔出血患者诊疗中的意义进行了探讨；结果血管痉挛与外伤性蛛网膜下腔出血的程度有关（P〈0．05）；血管痉挛累及的血管种类、数量血管痉挛持续的时间与预后密切相关（γ=0．642，P〈0．05），本研究同时比较了经颅多普勒频谱及血流速度改变对血管痉挛检测的意义，发现频谱改变早于流速改变；结论脑外伤性蛛网膜下腔出血后血管痉挛引起的血流动力学改变是影响外伤性蛛网膜下腔出血患者预后的重要因素。

The application of examination the hemodynamics in patients with traumatic subarachnoid hemorhage

Objective To provide a new and reliable marker for choosing methods and time window for the clinical prevention and treatment of traumatic subarachnoid hemorrhage, we explored the onset and progression of hemodynamic changes caused by cerebral vasospasm （CVS） and its effects on the prognosis in the patients with traumatic subarachnoid hemorrhage. Methods we performed continuous observation of the hemodynamic changes in 90 patients with traumatic subarachnoid hemorrhage with transcranial doppler ultrasonography （TCD）. We also investigated the significance of TCD technique in the diagnosis and treatment of traumatic subarachnoid hemorrhage. Results Cerebral vasospasm is associated with the severity of traumatic subarachnoid hemorrhage （ P 〈 0.05 ）. The locations and numbers of the vessels involved in cerebral vasospasm are associated with the prognosis （ P 〈 0. 05 ）. Also, the duration of cerebral vasospasm is significantly associated with the prognosis （γ = 0. 642, P 〈 0. 05 ）. In this study, we also compared the effects of TCD spectra parameters and blood flow speeds on cerebral vasospasm and found that TCD spectra parameters are changed earlier than blood flow speeds. Conclusion Hemodynamic changes in the patients with traumatic subarachnoid hemorrhage are important factors that affect the clinical prognosis.