【摘要】 目的研究经颅多普勒(TCD)对重症脑梗死患者颅内压力监测的临床意义。方法对33例重症脑梗死合并颅内压增高的患者(观察组)和53例无颅内压增高的脑梗死患者(对照组)分别于发病24h内、3d、7d进行TCD检测,并对观察组患者于脱水降颅压治疗前后进行TCD检测,观察平均血流速度(Vm)、脉动指数(PI)、阻力指数(RI)、血流参数指标及频谱形态特征。结果观察组于发病初期(24h内)、3d、7d时Vm均显著增快,PI、RI均显著升高,与对照组比较差异有显著性(P<0.05);观察组脱水治疗前Vm、PI、RI较脱水治疗后及对照组均显著升高(P<0.05);病变侧与病变对侧Vm、PI、RI差异有显著性(P<0.05)。TCD频谱形态在颅内压增高时呈现高阻力、高流速后低流速特点。结论TCD对重症脑梗死并颅内压增高具有特异性改变,是一种安全、无创、操作简便、重复性强、可靠而实用的监测颅内压的手段,同时TCD可用于了解脑血流的变化,以指导药物治疗,判断预后。更多还原

【Abstract】 Objective To study the practicality and reliability o f monitoring the intracranial pressure of the patients with the severe cerebral infarction with transcranial Doppler (TCD). Methods 33 patients with the s evere cerebral infarction with the intracranial pressure increase (observed grou p), and 53 patients with cerebral infarction without the intracranial pressure i ncrease (control group) were monitored by TCD at the initial stage (within 24 h) and after 3 d and 7 d. The observed group was also monitored with TCD before an d after the dehydration for intracranial decompression to test mean velocity (Vm ), pulsatility index (PI), resistance index (RI), blood flow parameter and the s pectrum patterns. Results In the observed group, the parameter Vm,PI,RI al l increased at the initial stage (within 24 h), 3 d and 7 d (P<0.05 compared wit h the control group). After the dehydration, Vm, PI, RI also increased significa ntly (P<0.05 compared with before dehydration). There was significant difference between the healthy side and sick side in Vm, PI, RI (P<0.05); The pattern of T CD appeared high resistance and high to slow flow velocity along with the growin g intracranial pressure. Conclusion TCD used for monitoring the patients w ith the severe cerebral infarction plus the intracranial pressure increase has s ignificant changes, which is a secure,hurtless, easy-to-operate and repeated, re liable and practical method to monitor the intracranial pressure. Simultaneously TCD was used to test the exit of the automatic mechanism of the blood flow in t he brain to instruct the treatment and judge the prognosis.更多还原