超声造影评估脑血流循环时间在无创颅内压监测中的应用

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目的:应用超声造影评估脑血流循环时间(cerebral blood flow circulation time,CCT)探索不同程度颅内压时CCT的变化规律,为无创颅内压监测提供新方法。方法:选取2019年1-12月空军军医大学唐都医院的10例颅内压增高的出血性脑卒中或急性颅脑创伤患者,在有创颅内压(invasive intracranial pressure,iICP)增高时(>20 mmHg)及降至正常时(≤20 mmHg)分别进行超声造影检查,测量并分析CCT,比较不同iICP时CCT的差异,分析CCT与iICP之间的关系。结果:①同一患者病变侧CCT在iICP增高时较iICP正常时明显延长,差异有统计学意义[(9.34±2.58)s对(6.48±1.91)s,n P=0.002]。②出血性脑卒中或急性颅脑创伤患者iICP增高时,病变侧与非病变侧CCT差异无统计学意义[(9.34±2.58)s对(9.01±3.22)s,n P=0.809]。③Pearson相关分析和Spearman等级相关分析显示患者呼吸、心率、二氧化碳分压、体温、GCS评分与CCT无相关性(均n P>0.05),年龄、平均动脉压与CCT存在中等程度相关(n r=0.518、0.463,n P=0.023、0.046)。④Logistic回归分析显示CCT是颅高压相关的独立风险因素(n OR=0.7,95%n CI=0.47~0.95,n P=0.036)。Logistic回归预测的受试者工作特征(ROC)曲线下面积(AUC)为0.750(0.588~0.912)。n 结论:超声造影无创评估CCT可以反映出血性脑卒中或急性颅脑创伤患者颅内压情况,CCT对颅高压有预测价值。当患者实施iICP监测条件受限,或后期拔出有创监测探头但仍需要评估颅内压时,CCT的改变可为临床诊治提供有效参考。“,”Objective:To evaluate the cerebral blood flow circulation time (CCT) by contrast-enhanced ultrasound, and to explore the change rule of CCT in different degree of intracranial pressure, so as to provide a new method for non-invasive monitoring of intracranial pressure.Methods:Ten patients with hemorrhagic stroke or acute craniocerebral trauma with increased intracranial pressure were selected from Tangdu Hospital, the Air Force Military Medical University from January to December 2019. Contrast-enhanced ultrasound was performed when the invasive intracranial pressure (iICP) increased (>20 mmHg, iICP increased group) and decreased to normal (≤20 mmHg, iICP normal group), CCT was measured and analyzed. The differences of CCTs between different iICP groups were compared and the relationship between CCT and iICP was analyzed.Results:①The CCT on the lesion sides of the same patients in the iICP increased group was significantly longer than in the iICP normal group[(9.34±2.58)s vs (6.48±1.91)s, n P=0.002]. ②When iICP was increased in patients with hemorrhagic stroke or acute craniocerebral trauma, the CCTs of the diseased side and the non-pathological side were not statistically significant [(9.34±2.58)s vs (9.01±3.22)s, n P=0.809]. ③Pearson correlation analysis and Spearman rank correlation analysis showed that there were no correlations between patient′s breathing, heart rate, carbon dioxide partial pressure, body temperature, GCS score and CCT (all n P>0.05). Age, mean arterial pressure and CCT were moderately correlated (n r=0.518, 0.463 and n P=0.023, 0.046, respectively). ④Logistic regression analysis showed that CCT was an independent risk factor related to intracranial hypertension(n OR=0.7, 95%n CI=0.47-0.95, n P=0.036). The area under ROC curve (AUC) predicted by logistic regression was 0.750(0.588~0.912).n Conclusions:Contrast-enhanced ultrasound noninvasive assessment of CCT can reflect the intracranial pressure in patients with hemorrhagic stroke or acute traumatic brain injury, and CCT has a predictive value for intracranial hypertension. When the patient has limited conditions for invasive intracranial pressure monitoring, or when the invasive monitoring probe is pulled out but still needs to evaluate intracranial pressure, the change of CCT can provide an effective reference for clinical diagnosis and treatment.
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