| 摘要: |
| 目的 探究经颅多普勒（TCD）血流动力学参数预测颅脑损伤后失代偿性颅高压的价值。方法 选择颅脑外伤患者122例，均接受TCD监测，每天1次，最长7天，若患者出现失代偿表现则停止检测。根据患者是否出现颅内压增高，定义为阳性组（35例）和阴性组（87例）。记录MCA血流动力学参数收缩期最大血流速度(Vs)、舒张期最大血流速度(Vd)、平均血流速度(Vm)及搏动指数(PI)、阻抗指数(RI)，以及参数的改变量△Vs、△Vd、△Vm、△PI及△RI。比较阳性组及阴性组患者血流动力学参数值及其变化值，分析MCA血流动力学参数的变化趋势。利用COX回归分析潜在指标提示失代偿性颅高压的风险，运用ROC曲线分析其预测失代偿性颅高压的准确性。结果 本研究中的122例颅脑外伤患者失代偿性颅高压的发生率约为28%。阴性组Vs、Vm以及Vd在监测期内均呈下降趋势，RI及PI呈上升趋势。阳性组的Max (△PI)大于阴性组，差异有统计学意义（P=0.014）。Max (△PI)能够独立提示失代偿性颅高压的风险（HR=1.71，P=0.027）。其预测失代偿性颅高压的AUC为0.904，最佳诊断值为0.148，敏感性80.00%，特异性90.80%。结论 利用TCD监测并计算Max(△PI)可较为准确地预测颅脑损伤后尚处于代偿期的患者发展为颅高压的概率。 |
| 关键词: 经颅多普勒，血流动力学参数，颅脑损伤，颅内压，失代偿期 |
| DOI： |
| 投稿时间：2020-07-10修订日期：2020-08-08 |
| 基金项目:2019年度桐乡市引导性科技计划项目 |
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| Diagnostic value of transcranial Doppler hemodynamic parameters to predict cranial hypertension after craniocerebral injury |
| Shen Huiying,Sheng Xiaojie,Shen Xiaoping,Zhang Jianshe |
| (Tongxiang Second People''''s Hospital Jiaxing) |
| Abstract: |
| Objective To explore the value of transcranial Doppler (TCD) hemodynamic parameters in predicting decompensated intracranial hypertension after craniocerebral injury. Methods A total of 122 patients with craniocerebral injury were monitored by TCD once a day for up to 7 days. The detection would be stopped if the patient showed decompensation. According to the results of cranial hypertension, patients were included in the positive group (n=35) and negative group (n=87). The hemodynamic parameters of MCA, such as systolic maximum blood flow velocity (VS), diastolic maximum blood flow velocity (VD), mean blood flow velocity (VM), pulsation index (PI), impedance index (RI), and the changes of parameters △Vs、△Vd、△Vm、△PI and △RI were recorded. The hemodynamic parameters of the positive and negative groups were compared, and the trend of hemodynamic parameters of MCA was analyzed. Cox regression analysis was used to reveal the risk of decompensated intracranial hypertension. ROC curve was used to analyze the accuracy of predicting decompensated intracranial hypertension. Results The incidence of decompensated intracranial hypertension in 122 patients with craniocerebral injury was about 28%. In the negative group, Vs, Vm and Vd showed a downward trend in the monitoring period, while RI and PI showed an upward trend. The max (△PI) of positive group was higher than that of the negative group, and the difference was statistically significant (P = 0.014). Max (△PI) can independently indicate the risk of decompensated intracranial hypertension (HR=1.71, P=0.027). The AUC of predicting decompensated intracranial hypertension was 0.904. The best diagnostic value was 0.148, and the sensitivity and specificity was 80.00% and 90.80%, respectively. Conclusion Using TCD to monitor and calculate max (△PI) can more accurately predict the probability of decompensated intracranial hypertension in patients who are still in compensatory period after craniocerebral injury. |
| Key words: Transcranial Doppler, hemodynamic parameters, craniocerebral injury, intracranial pressure, decompensation period |
