CAJ | 학술논문

目的：探讨经颅多普勒（TCD）与闪光视觉诱发电位（FVEP）对脑出血微创术疗效的评估价值。方法选择2013年1~12月期间我院脑科收治的60例高血压性基底节区大量脑出血患者作为此次调查对象，所有患者均于发病24h内入院。并根据治疗方法的差异将患者分为微创手术组及内科保守组，两组患者均于病程第1天及第7天行TCD及FVEP检查，并对诊断中所得的血流动力学参数、各波潜伏期、NIHSS评分及GCS评分结果进行比较，同时以TCD及FVEP两种无创方法预测颅内压。结果较保守组而言，微创组患者第1天的TCD参数、FVEP各波潜伏期、NIHSS评分、GCS评分及预测颅内压均无明显改变；而微创组患者第7天脑血流速度明显加快，搏动指数降低，FVEP各波潜伏期均显著缩短，预测颅内压显著降低。较第1天而言，微创组患者第7天脑血流速度明显加快，搏动指数降低，FVEP的N2、P3波潜伏期显著缩短，但NIHSS及GCS评分无显著变化，预测颅内压显著降低。结论脑出血微创术具有降低颅内压、改善急性期神经功能的效果，TCD及FVEP可对微创手术疗效进行价值性的评估。
목적：탐토경로다보륵（TCD）여섬광시각유발전위（FVEP）대뇌출혈미창술료효적평고개치。방법선택2013년1~12월기간아원뇌과수치적60례고혈압성기저절구대량뇌출혈환자작위차차조사대상，소유환자균우발병24h내입원。병근거치료방법적차이장환자분위미창수술조급내과보수조，량조환자균우병정제1천급제7천행TCD급FVEP검사，병대진단중소득적혈류동역학삼수、각파잠복기、NIHSS평분급GCS평분결과진행비교，동시이TCD급FVEP량충무창방법예측로내압。결과교보수조이언，미창조환자제1천적TCD삼수、FVEP각파잠복기、NIHSS평분、GCS평분급예측로내압균무명현개변；이미창조환자제7천뇌혈류속도명현가쾌，박동지수강저，FVEP각파잠복기균현저축단，예측로내압현저강저。교제1천이언，미창조환자제7천뇌혈류속도명현가쾌，박동지수강저，FVEP적N2、P3파잠복기현저축단，단NIHSS급GCS평분무현저변화，예측로내압현저강저。결론뇌출혈미창술구유강저로내압、개선급성기신경공능적효과，TCD급FVEP가대미창수술료효진행개치성적평고。
Objective To investigate the appralsal value of the transcranial doppler (TCD) and flash visual evoked potential (FVEP) on minimally invasive surgery for cerebral hemorrhage. Methods 60 patients with hypertensive massive cerebral hemorrhage in basal ganglia and who were treated in the department of cerebral surgery of our hospital from January 2013 to December 2013 were selected as the investigation objects of this time, and all the patients were admitted within 24h after the onset of the disease. In addition, the patients were divided into the group received minimally invasive operation and the group received medical conservative treatment according to the difference of treatment methods, and all the patients of the both groups were received examinations of TCD and FVEP on the first day and the seventh day of the disease course, and hemodynamic parameters, the latency of each wave, and the results of NIHSS score and GCS score obtalned in the process of diagnosis were compared, and the intracranial pressures were predicted by the two kinds of noninvasive methods, TCD and FVEP, at the same time. Results compared with the conservative group, TCD parameters, the latencies of each wave of FVEP, NIHSS scores, GCS scores and predicted intracranial pressures on the first day in the patients of minimally invasive group did not change significantly;and cerebral blood flow velocities on the seventh day in the patients of minimally invasive group were accelerated significantly, the pulsatility indexes were decreased, all the latencies of each wave of FVEP were shortened significantly and the predicted intracranial pressures were decreased significantly. When compared with the first day, cerebral blood flow velocities on the seventh day in the patients of minimally invasive group were accelerated significantly, the pulsatility indexes were decreased, and the latencies of N2 and P3 waves of FVEP were shortened significantly, but the NIHSS and GCS scores did not change significantly, and the predicted intracranial pressures were shortened obviously. Conclusion minimally invasive surgery for cerebral hemorrhage has the effect to reduce intracranial pressure and improve neurological function in acute stage, and TCD and FVEP can be used to carry out the valuable evaluation for the curative effect of minimally invasive operation.