摘要
目的应用经颅多普勒检测大脑中动脉(MCA)血流动力学参数,探讨其预测颅脑损伤后颅内高压综合征(ICH)的价值。方法前瞻性选择颅脑外伤患者122例,均接受经颅多普勒(TCD)监测,每天1次,最长7 d,若患者出现失代偿表现则停止检测。根据患者在检测期内是否出现ICH分为ICH组35例和非ICH组87例。记录MCA的收缩期峰值速度(Vs)、舒张期末速度(Vd)、平均速度(Vm)、搏动指数(PI)及阻力指数(RI),计算各参数对应的最大变化值和平均变化值(ΔVsMax和ΔVsMean、ΔVdMax和ΔVdMean、ΔVmMax和ΔVmMean、ΔRIMean和ΔRIMax、ΔPIMean和ΔPIMax),并对两组进行比较;分析MCA血流动力学参数随时间变化的趋势。采用COX回归筛选ICH风险的独立预测指标,绘制受试者工作特征(ROC)曲线分析其预测ICH发生风险的诊断效能。结果非ICH组MCA血流动力学参数Vs、Vm、Vd随监测时间均呈下降趋势,RI和PI呈上升趋势。与非ICH组比较,ICH组ΔPIMax值增大(P=0.014);其余参数比较差异均无统计学意义。COX回归分析提示,ΔPIMax是ICH发生风险的独立预测因子(HR=1.710,P=0.027)。ROC曲线分析显示,ΔPIMax截断值为0.148,预测ICH发生风险的曲线下面积为0.904,敏感性为80.00%,特异性为90.80%。结论应用经颅多普勒可监测MCA血流动力学变化,其中ΔPIMax能准确预测颅脑损伤后ICH的发生。
Objective To explore the value of transcranial Doppler(TCD)hemodynamic parameters in predicting intracranial hypertension(ICH)after craniocerebral injury.Methods A total of 122 patients with craniocerebral injury were prospectively enrolled and received TCD monitoring once a day for up to 7 d.The test would be stopped if the patients showed decompensation.According to the presence of ICH,patients were divided into ICH group(n=35)and non-ICH group(n=87).The peak systolic velocity(Vs),end diastolic velocity(Vd),mean velocity(Vm),pulsatility index(PI),and resistance index(RI)of middle cerebral artery(MCA)were recorded.The maximum and mean values of each parameterΔVsMax andΔVMean,ΔVdMax andΔVdMean,△VmMax and△VmMean,ΔRIMean andΔRIMax,ΔPIMean andΔPIMax were calculated and compared.The trend of MCA hemodynamic parameters over time was analyzed.COX regression analysis was used to screen independent predictors for the risk of ICH,and the ROC curve was drawn to analyze the diagnostic efficacy in identifying ICH.Results The MCA hemodynamic parameters(Vs,Vm,and Vd)of patients in the non-ICH group showed a downward trend during the monitoring time,while RI and PI showed an upward trend.Compared with the non-ICH group,theΔPIMax value in the ICH group was increased(P=0.014).COX regression analysis indicated thatΔPIMax was an independent predictor of ICH(HR=1.710,P=0.027).ROC curve analysis indicated thatΔPIMax was a good indicator for identifying ICH(AUC=0.904),cut-off value was 0.148,the sensitivity and specificity were 80.00%and 90.80%,respectively.ConclusionΔPIMax of MCA can accurately identify ICH,and is hope to be used as a new indicator to predict ICH.
作者
沈恵英
盛晓杰
柯巧航
刘雪刚
张建设
沈小平
SHEN Huiying;SHENG Xiaojie;KE Qiaohang;LIU Xuegang;ZHANG Jianshe;SHEN Xiaopin(Department of Ultrasound,the Second People's Hospital of Tongxiang,Zhejiang 314511,China)
出处
《临床超声医学杂志》
CSCD
2021年第2期105-109,共5页
Journal of Clinical Ultrasound in Medicine
基金
2019年度桐乡市引导性科技计划项目(201902283)。
关键词
超声检查
多普勒
彩色
经颅
血流动力学参数
颅脑损伤
颅内压
失代偿期
Ultrasonography,Doppler,color,transcranial
Hemodynamic parameters
Craniocerebral injury
Intracranial pressure
Decompensated period
