经颅多普勒（TCD）无创颅内压监测技术在重度颅脑损伤中的临床应用研究

发布时间：2018-06-17 13:29

本文选题：颅内压 + 经颅多普勒　；参考：《浙江大学》2015年硕士论文

【摘要】：目的：对重度颅脑损伤患者的TCD频谱图像及参数特征进行监测,了解不同程度的颅内高压的频谱图像特征及其参数,并与ICP监测结果进行对照分析,旨在探讨TCD监测颅脑损伤患者ICP的临床应用价值,为临床应用提供参考依据。方法：对进行手术治疗的48例颅脑外伤患者在手术结束时在颅内放置微型传感器探讨,持续监护患者的ICP。术后次日采用TCD技术经患侧颞窗获取大脑中动脉(MCA)的超声频谱图像,同时测量MCA的收缩期峰血流速度(Vs)、舒张期末血流速度(Vd)、平均血流速度(Vm)并计算搏动指数(PI)和阻力指数(RI),记录即时的ICP值。根据患者ICP增高的程度进行分组,分析比较各组患者的TCD频谱图像特征及参数改变情况。结果： 1.转归：ICP正常组和ICP轻度增高组患者共25例,治愈19例,中度残疾6例；12例ICP中度增高患者中,其中2例脑水肿肿胀进行性加重,ICP持续升高而导致患者死亡,1例病情好转后转院,重度残废1例,3例中度致残,余5例治愈出院；11例ICP重度增高患者中,其中死亡6例,自动出院1例,重度残废3例,中度残废1例。 2.频谱图像：与ICP正常组相比,ICP轻度增高组的频谱图像无明显改变；ICP中度增高组的频谱图像显示D峰前切迹加深；ICP重度增高组的频谱图像特征性改变为S2峰消失和出现“单尖峰”,舒张期血流下降明显。 3.TCD参数：舒张期末血流速度(Vd)、平均血流速度(Vm)随着ICP的逐渐升高而呈现出下降趋势。将各组数据分别与ICP正常组进行比较,结果显示ICP轻度增高组患者的Vd和Vm下降不明显,差异无统计学意义(p0.05)；ICP中度增高组患者的Vd和Vm下降明显,差异有统计学意义(p0.05)；ICP重度增高组患者的Vd和Vm下降最为显著,具有显著的统计学差异(p0.01)。PI和RI随着ICP的逐渐升高而呈现出上升趋势。ICP轻度增高组的各参数与ICP正常者相比,差异无统计学意义(pO.05),ICP中、重度增高组中参数PI、RI、Vd及Vm与ICP正常者相比,差异有统计学意义(p0.05)。结论： ICP增高早期或轻度增高时,TCD频谱图像及参数无明显改变。 TCD频谱图像中切迹加深可提示ICP已达到中度增高；而当TCD频谱表现为“单尖峰”和S2峰消失时,可提示ICP已达到重度增高；与正常颅内压者相比,除收缩期峰血流速度(Vs)外,ICP中重度增高患者的TCD其他参数均有统计学差异；与参数相比,TCD的频谱图像特征更能直观反映颅脑损伤患者的ICP变化趋势。
[Abstract]:Objective: to monitor the spectral images and parameters of TCD in patients with severe craniocerebral injury, to understand the characteristics and parameters of different degree of intracranial hypertension, and to compare the results with ICP. To explore the clinical application value of TCD monitoring ICP in patients with craniocerebral injury and to provide reference for clinical application. Methods: 48 patients with craniocerebral trauma were treated with microsensors at the end of operation. The next day after operation, the TCD technique was used to obtain the ultrasound spectrum of the middle cerebral artery (MCA) through the affected temporal window. At the same time, systolic peak blood flow velocity (VsN), end-diastolic flow velocity (VDV), mean blood flow velocity (Vm) of MCA were measured, pulsatility index (Pi) and resistance index (RI) were calculated, and ICP values were recorded. According to the degree of ICP elevation, the characteristics and parameters of TCD spectrum images were analyzed and compared. Results: 1. There were 25 cases in normal group and mild increase group of ICP, 19 cases were cured, 6 cases were moderate disability, 12 cases were moderately elevated ICP, Among them, 2 cases of brain edema swelling and progressive aggravation of ICP caused the death of 1 patient, 1 case of severe disability, 1 case of severe disability, 3 cases of moderate disability, the remaining 5 cases cured and discharged from hospital 11 cases with severe increase of ICP, among which 6 cases died. One case was discharged automatically, 3 cases were severely disabled and 1 case was moderately disabled. Spectrum image: compared with the normal ICP group, the frequency spectrum image of the mild elevated ICP group had no significant change, and the spectrum image of the moderate increased ICP group showed that the D peak pre-notch was deeper than that of the normal ICP group. The characteristic changes of spectrum image in the patients with severe ICP elevation were the disappearance of S2 peak and the appearance of "single spike". 3. TCD parameters: end diastolic velocity (VDX), mean blood flow velocity (Vm) showed a decreasing trend with the increase of ICP. The data of each group were compared with that of normal ICP group. The results showed that there was no significant decrease in VD and VM in patients with mild increase of ICP, but there was no significant difference in VD and VM in patients with moderate increase of ICP, and the difference was statistically significant (P 0.05). VD and VM decreased most significantly in patients with severe elevated ICP. There was significant statistical difference in Pi and RI with the increase of ICP. There was no significant difference in the parameters of patients with mild increase of ICP compared with that of patients with normal ICP, and there was no significant difference in ICP between the two groups. There was a significant difference in the parameters of Pi, RI, VD and VM between the patients with severe elevation and those with normal ICP (P 0.05). Conclusion: there is no significant change in TCD spectrum and parameters in the early stage or slightly elevated of ICP, and the deepening of the notch in TCD spectrum image may indicate that ICP has reached a moderate increase. However, when the TCD spectrum showed "single spike" and S2 peak disappeared, ICP had reached a severe increase, compared with that in normal intracranial pressure patients. The other parameters of TCD in patients with moderate and severe increase of ICP except systolic peak blood flow velocity (Vs) were statistically different, and compared with the parameters, the spectral features of TCD could directly reflect the trend of ICP in patients with craniocerebral injury.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.15

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