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目的:研究基于卒中登记的颅内动脉瘤致蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,a SAH)的颅脑血流动力学改变及其对诊断治疗的指导作用。方法:采用回顾性研究经卒中登记系统筛选出48例经DSA(digital subtraction angiography,DSA)确诊的a SAH,收集患者床旁经颅多普勒(transcranial Doppler,TCD)监测大脑中动脉(middle cerebral artery,MCA)的动脉平均峰值流速(mean blood velocity,Vm)、搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI),自身健侧作为正常对照,均采用血管内介入治疗,对其中符合脑血管痉挛(cerebral vasospasm,CVS)诊断标准的患者使用尼莫地平进行治疗,观察疗效。结果:与健侧相比,患侧PI、RI增大,Vd、Vm减小,其中以Vd减小较明显,与健侧相比有统计学差异(P<0.01),Vs与健侧相比无统计学差异(P>0.05)。CVS组与非CVS组相比Vm明显增加,有统计学差异(P<0.001)。所有患者经水膨胀弹簧圈或支架预后均得到改善。结论:床旁实时TCD监测能反映a SAH脑血流变化,对CVS进行及时解除痉挛治疗,并为介入治疗提供参考依据,颅脑血流实时监测和介入治疗综合运用提高了a SAH患者的治疗效果。
Objective: To study the changes of cerebral hemodynamics based on stroke registered aneurysmal subarachnoid hemorrhage (a SAH) and its guiding role in the diagnosis and treatment. Methods: A retrospective study was conducted to identify a SAH diagnosed by digital subtraction angiography (DSA) in 48 patients who had been diagnosed by transcranial Doppler (TCD) at the bedside. A middle cerebral artery The mean blood velocity (Vm), pulsatility index (PI), resistance index (RI), and their contralateral side as the normal control were measured by using endovascular interventional therapy Among them, patients meeting the diagnostic criteria of cerebral vasospasm (CVS) were treated with nimodipine to observe the curative effect. Results: Compared with contralateral side, PI and RI of affected side increased, Vd and Vm decreased, especially Vd decreased more obviously than that of contralateral side (P <0.01) No significant difference (P> 0.05). Vm in CVS group was significantly higher than that in non-CVS group (P <0.001). The prognosis of all patients with water-expanded coils or stents was improved. Conclusion: The bedside real-time TCD monitoring can reflect the change of a SAH cerebral blood flow, relieve the spasm of CVS in time and provide a reference for interventional therapy. Real-time monitoring of cranial blood flow and interventional therapy can improve the treatment of a SAH patients effect.