CAJ | 학술논문

目的探讨经颅多普勒超声(TCD)对重型颅脑损伤患者脑死亡诊断的临床价值.方法将天津医科大学—中心临床学院神经外科收治的40例重型颅脑损伤患者[格拉斯哥昏迷评分(GCS)≤8分]按预后分为死亡组(15例)与存活组(25例),利用TCD动态检测大脑中动脉(MCA)频谱形态、舒张期逆行血流(RDF)出现率、MCA平均血流速度(MCA-Vm),计算搏动指数(PI).结果存活组中3例患者均在伤后24 h内出现部分RDF,持续时间短,均未超过12h,经药物或手术治疗后RDF波形均很快消失,但此类患者生存质量均差,6个月后随访格拉斯哥预后评分{ GOS)仅为2分,均为植物生存状态.死亡组中12例患者出现完全RDF,2例出现钉子波形改变,且14例患者脑死亡的特征性血流改变的出现早于临床脑死亡6～40h.与存活组比较,死亡组MCA-Vm(cm/s)明显降低(20.07±13.97比56.72±16.87),PI明显升高(3.95±3.51比1.25±1.06),RDF频谱出现率明显增高(93.3％比12.0％),差异均有统计学意义(P＜0.05或P＜0.01).结论 TCD脑血流动力学检测具有操作简单、床旁可行、无创伤、不受镇静药物干扰及可重复等优点,对于早期诊断重型颅脑损伤患者脑死亡具有较高的临床实用价值.
목적 탐토경로다보륵초성(TCD)대중형로뇌손상환자뇌사망진단적림상개치.방법 장천진의과대학—중심림상학원신경외과수치적40례중형로뇌손상환자[격랍사가혼미평분(GCS)≤8분]안예후분위사망조(15례)여존활조(25례),이용TCD동태검측대뇌중동맥(MCA)빈보형태、서장기역행혈류(RDF)출현솔、MCA평균혈류속도(MCA-Vm),계산박동지수(PI).결과 존활조중3례환자균재상후24 h내출현부분RDF,지속시간단,균미초과12h,경약물혹수술치료후RDF파형균흔쾌소실,단차류환자생존질량균차,6개월후수방격랍사가예후평분{ GOS)부위2분,균위식물생존상태.사망조중12례환자출현완전RDF,2례출현정자파형개변,차14례환자뇌사망적특정성혈류개변적출현조우림상뇌사망6～40h.여존활조비교,사망조MCA-Vm(cm/s)명현강저(20.07±13.97비56.72±16.87),PI명현승고(3.95±3.51비1.25±1.06),RDF빈보출현솔명현증고(93.3％비12.0％),차이균유통계학의의(P＜0.05혹P＜0.01).결론 TCD뇌혈류동역학검측구유조작간단、상방가행、무창상、불수진정약물간우급가중복등우점,대우조기진단중형로뇌손상환자뇌사망구유교고적림상실용개치.
Objective To assess the clinical value of transcranial Doppler (TCD) ultrasonography in diagnosing brain death in patients with severe craniocerebral injury.Methods Forty patients of severe craniocerebral injury defined by a scene Glasgow coma scale (GCS) ≤8,admitted to Department of Neurosurgery of First Central Clinical Hospital of Tianjin Medical University,were divided into two groups based upon the prognosis:the death group (n =15) and the survival group (n=25).All patients were examined dynamically by TCD,and the occurrence of retrograde diastolic flow (RDF) and mean velocity (Vm) of middle cerebral arteries (MCA) were measured as well as the pulse index (PI).Results In the survival group,3 showed partial RDF which was found within 24 hours after injury,and the duration was short lasting for no more than 12 hours,and the RDF wave disappeared very quickly after treatment of drug or operation.These patients were in persistent vegetative state with Glasgow outcome score(GOS) 2,having been followed up for 6 months.In the death group,12 showed fully RDF,2 showed very small systolic spike.The characteristic change of 14 patients' cerebral hemodynamics took place 6-40 hours before clinical brain death.Compared with survival group,Vm of MCA (cm/s) was significantly decreased(20.07 ± 13.97 vs.56.72 ± 16.87),the value of PI was significantly increased (3.95 ± 3.51 vs 1.25 ± 1.06),and the occurrence of RDF was also elevated (93.3％ vs.12.0％) in the death group,the differences were statistically significant (P＜0.05 or P＜0.01).Conclusion TCD with the advantages of easy and bedside operation,noninvasiveness,no disturbance from sedatives and repeatability in cerebral homodynamic examination is of great clinic practical value in early diagnosing brain death in patients with severe cranial injury.