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重庆医科大学附属第一医院神经外科
纸质出版日期:2009,
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[1]邓超,孙晓川.TCD无创监测颅脑外伤患者ICP变化的临床价值探讨[J].重庆医科大学学报,2009,34(07):938-942.
DENG Chao, et al. Study of clinical value of noninvasive intracranial pressure monitoring with TCD in patients with traumatic brain injury[J]. Journal of Chongqing Medical University, 2009,34(7):938-942.
目的:通过对颅脑外伤患者的颅内压(Intracranial pressure
ICP)和经颅多普勒(Transcranial doppler ultrasonography
TCD)监测结果进行对比分析
以进一步评估TCD无创监测ICP的临床应用价值。方法:对进行手术治疗的32名脑外伤患者行持续床旁ICP监测
术后次日采用经颅多普勒超声床旁检测患侧大脑中动脉的频谱图像及各参数并记录即时的颅内压值
按颅内压进行分组
将颅内压增高的各组的TCD频谱图像和参数与颅内压正常组进行比较分析。结果:(1)频谱图像:颅内压轻度增高组的频谱图像和颅内压正常组无明显差别
在颅内压中度增高组中有D峰前切迹加深现象
颅内压重度增高组中有S2峰消失和"单尖峰"出现
舒张期血流下降明显。(2)TCD参数:随着ICP增高
Vs、Vd和Vm均逐渐下降
以Vd下降最明显
而PI和RI则逐渐升高。结论:TCD进行无创的颅内压监测有一定的临床应用价值
对颅脑外伤患者在颅内压增高明显时能有提示
但不能在颅内压增高的早期作出明确的提示
对颅内压增高的判断频谱图像优于参数。
Objective: This study was designed to analyze the results from ICP and TCD monitoring in patients with traumatic brain injury (TBI) in order to further evaluate the clinical significance of noninvasive ICP monitoring with TCD. Methods:The monitoring and measurements with TCD were performed beside beds on the following day of surgery to record the spectral atlas and parameter of the middle cerebral artery (MCA) of suffering side in 32 patients with TBI. The values of ICP were recorded at the same time. The patients were divided into four groups according to ICP. The comparative analyses of results of TCD and ICP monitoring were carried out.Results:(1)Spectral atlas: The spectral atlas of Mild ICP Increase Group showed no visible differences from those of Normal ICP Group.A phenomenon of deepened notch before reaching D peak was found in some cases of Moderate ICP Increase Group while occurrence of single cusp peak and disappearance of S2 peak with decreased diastolic velocity were observed in Severe ICP Increase Group. (2) Parameter of TCD: With the increase of ICP
Vs
Vd and Vm were decreased accordingly with the most significant dropping in Vd while PI and RI were elevated gradually. Conclusion:This study suggests that TCD can be applied to monitor noninvasively ICP and indicate the significant increase of ICP in patients with TBI
but fail to detect mild increase of ICP. Spectral atlas is superior to parameters of TCD in judgment of increased ICP
颅内压经颅多普勒颅脑外伤临床应用
Intracranial pressure(ICP)Transcranial doppler ultrasonography(TCD)Traumatic brain injury(TBI)Clinic application
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