[1]安红伟),卢昌均)#,程岗).蛛网膜下腔出血急性期患者脑血流动力学监测及颅内压预测*[J].郑州大学学报(医学版),2011,(06):858.
 AN Hongwei,LU Changjun,CHENG Gang.Haemodynamic monitoring of cerebrospinal fluid and intracranial pressure prediction in patients at the acute stage of subarachnoid hemorrhage[J].JOURNAL OF ZHENGZHOU UNIVERSITY(MEDICAL SCIENCES),2011,(06):858.
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蛛网膜下腔出血急性期患者脑血流动力学监测及颅内压预测*
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《郑州大学学报(医学版)》[ISSN:1671-6825/CN:41-1340/R]

卷:
期数:
2011年06期
页码:
858
栏目:
论著
出版日期:
2011-11-20

文章信息/Info

Title:
Haemodynamic monitoring of cerebrospinal fluid and intracranial pressure prediction in patients at the acute stage of subarachnoid hemorrhage
作者:
安红伟1)卢昌均1)#程岗2)
1)柳州市中医院神经内科 柳州 545001 2)第四军医大学西京医院神经外科 西安 710032
Author(s):
AN Hongwei1)LU Changjun1)CHENG Gang2)
1)Department of Neurology,Liuzhou Traditional Chinese Medicine Hospital,Liuzhou 545001 2)Department of Neurosurgery,Xijing Hospital,the Forth Military Medical University,Xi'an 710032
关键词:
颅内压经颅多普勒蛛网膜下腔出血
Keywords:
intracranial pressuretranscranial Dopplersubarachnoid hemorrhage
分类号:
R743.35
摘要:
目的:应用经颅多普勒(TCD)监测蛛网膜下腔出血(SAH)急性期患者的脑血流动力学变化,评估脑脊液置换减轻脑血管痉挛(CVS)的疗效,并进而无创预测颅内压(ICP)。方法:将60例SAH患者随机分为脑脊液置换组与非置换组各30例,发病第1、3、5、7天均行TCD检测,记录收缩期峰血流速度(vs)、舒张期末血流速度(vd)、平均血流速度(vm)及搏动指数(PI)。置换组每次检测完成后立即行腰椎穿刺、脑脊液测压并行脑脊液置换,非置换组仅行脑脊液测压。结果:2组患者病程不同时间点间vs、vm及vd差异均有统计学意义,组间效应及交互效应vs差异亦有统计学意义(P均<0.05);置换组血流速度第5天达高峰,第7天稍有减慢,而非置换组呈逐渐增快趋势,第7天达高峰;与非置换组比较,置换组CVS发生率降低(χ2=6.239,P=0.012),程度减轻。以PI为解释变量,ICP为反应变量建立回归方程:ICP=4.666+15.246×PI(F=93.275,P<0.001)。应用该回归方程对ICP进行预测,与实际ICP相比,预测差值在5 mmHg内者占85.6%。结论:SAH急性期患者脑血流速度呈增快趋势,脑脊液置换可有效减轻CVS;TCD可较为准确地无创预测SAH急性期患者的ICP。
Abstract:
Aim:To investigate the effect of cerebrospinal fluid(CSF) exchange in decreasing cerebral vascular spasm (CVS) by monitoring CSF dynamics using transcranial Doppler(TCD) in patients at the acute stage of subarachnoid hemorrhage(SAH), and investigate the value of TCD on intracranial pressure(ICP) prediction.Methods:Sixty SAH patients were randomly allocated into CSF exchange group and nonCSF exchange group, with 30 patients in each group. TCD examination was carried out at 1 d, 3 d, 5 d and 7 d after SAH onset and haemodynamic parameters of TCD[(systolic velocity(vs), mean velocity(vm), diastolic velocity(vd) and pulsatility index(PI)]were recorded. ICP was measured by lumbar puncture shortly after TCD examination.CSF exchange was performed after ICP measurement in CSF exchange group.Results:There was significant difference in vs, vm and vd at different time points, and there was significant difference in vs between the 2 groups.In CSF exchange group the velocity reached peak at 5 d and decreased at 7 d,which increased with time and reached peak at 7 d in nonCSF exchange group. The incidence of CVS was lower in CSF exchange group than that in nonCSF exchange group(χ2=6.239,P=0.012).According to changes of TCD parameters and ICP, ICP was predicted by the equation: ICP=4.666+15.246×PI (F=93.275,P<0.001),which could predict ICP accurately.Conclusion: Blood flow velocity increases significantly in patients at the acute stage of SAH and CSF exchange can effectively decrease CVS. TCD can accurately predict ICP in SAH patients.

参考文献/References:

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备注/Memo

备注/Memo:
*广西壮族自治区卫生厅自筹经费科研项目Z2009259 #通讯作者,男,1963年7月生,博士,副主任医师,研究方向:神经危重病监护与治疗,Email:lchj477@yahoo.com.cn
更新日期/Last Update: 1900-01-01