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山东大学学报（医学版） ›› 2017, Vol. 55 ›› Issue (11): 38-41.doi: 10.6040/j.issn.1671-7554.0.2017.223

• 临床医学 • 上一篇    下一篇

经颅多普勒超声早期预测动脉瘤夹闭术后迟发性脑缺血的临床分析

王谋龙1,陈永坤2,邢德广3,曲良锁1,王成伟3   

  1. 1.山东能源淄博矿业集团中心医院神经外科, 山东 淄博 255120;2.山东大学附属济南市中心医院超声科, 山东 济南 250013;3.山东大学第二医院神经外科, 山东 济南 250033
  • 收稿日期:2017-03-16 出版日期:2017-11-10 发布日期:2017-11-10
  • 通讯作者: 邢德广. E-mail:xideguang_2003@163.com E-mail:xideguang_2003@163.com
  • 基金资助:
    山东大学第二医院科研基金(S2014010011)

A clinical analysis of transcranial Doppler in predicting delayed cerebral ischemia after ruptured aneurysm surgery

WANG Moulong1, CHEN Yongkun2, XING Deguang3, QU Liangsuo1, WANG Chengwei3   

  1. 1. Department of Neurosurgery, Central Hospital of Shandong Energy Zibo Mining Group Co., Ltd, Zibo 255120, Shandong, China;
    2. Department of Ultrasound, Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, Shandong, China;
    3. Department of Neurosurgery, Second Hospital of Shandong University, Jinan 250033, Shandong, China
  • Received:2017-03-16 Online:2017-11-10 Published:2017-11-10

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摘要： 目的 评价经颅多普勒超声(TCD)对破裂动脉瘤夹闭术后迟发性脑缺血(DCI)预测的敏感性,并初步探讨影响DCI的危险因素。 方法 回顾性分析67例破裂动脉瘤行开颅夹闭手术的患者临床资料,分别用ROC曲线和Logistic回归分析TCD对DCI的预测情况及影响DCI的危险因素。 结果 出现DCI 18例,发生率为26.9%;大脑中动脉平均血流速度(MCAVm)为149.5 cm/s时对DCI的预测准确性最高,其灵敏度和特异度分别为88.9%和81.6%;改良Fisher分级和MCAVm≥130 cm/s与DCI的发生有显著相关性。 结论 TCD早期动态监测可有效预测动脉瘤夹闭术后DCI,是指导治疗和减少缺血性神经功能损害的有效手段,并对改善患者预后有重要临床意义,且改良Fisher分级和MCAVm≥130 cm/s是DCI发生的危险因素。

关键词: 经颅多普勒, 动脉瘤, 显微外科手术, 迟发性脑缺血, 蛛网膜下腔出血

Abstract: Objective To evaluate the sensibility of transcranial Doppler(TCD)in predicting delayed cerebral ischemia(DCI)after ruptured aneurysm surgery, and to explore the risk factors of DCI. Methods Clinical data of 67 patients with ruptured aneurysm who received intracranial aneurysmal clipped operation were retrospectively analyzed. Receiver operator characteristic curve(ROC)and Logistic regression were adopted to analyze the diagnostic accuracy and risk factors of DCI. Results DCI occurred in 18 of all patients, with an incidence rate of 26.9%. When the middle cerebral artery mean blood flow velocity(MCAVm)was 149.5 cm/s, TCD had the highest predicting accuracy, and the sensitivity and specificity were 88.9% and 81.6%, respectively. Modified Fisher grade and MCAVm≥130 cm/s were significantly correlated with the occurrence of DCI. Conclusion Early dynamic TCD monitoring can effectively predict DCI, guide the treatment and reduce the ischemic neurological deficits. Modified Fisher grade and MCAVm≥130 cm/s are the risk factors of DCI.

Key words: Delayed cerebral ischemia, Arterial aneurysm, Subarachnoid hemorrhage, Transcranial Doppler, Microsurgery

中图分类号: 

  • R737.31
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