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目的探讨大面积脑梗死后颅内血流动力学动态的变化特点。方法对58例大面积脑梗死患者采用影像学供血模型分为完全MCA型和MCA皮质型,利用床旁经颅彩色多普勒(TCD)于入院当天和1周内隔日1次及第14天动态检测颅内血流情况,通过测定脑底动脉血流速度、搏动指数及血流速度比值(RVACA),观察颅内血管血流动力学变化。结果大面积脑梗死病灶侧大脑中动脉(MCA)平均血流速度(Vm)、颈内动脉(ICA)平均血流速度均明显低于对照组(P<0.05),完全MCA型组较MCA皮质型组MCA血流速度明显减慢;完全MCA型与MCA皮质型梗死后动态观察MCA血流变化不明显,NIHSS评分及Pi在第3、5、7天较第1天明显增高(P<0.05),NIHSS评分变化最明显。结论大面积脑梗死患者可通过床旁TCD动态检测,及时发现侧支循环代偿及血管再通情况,评价颅内压动态变化,结合神经功能缺损评分,观察脱水降颅压治疗反应,为患者选择合适的治疗方案提供依据。
Objective To investigate the dynamic changes of intracranial hemodynamics after large area cerebral infarction. Methods Fifty-eight patients with large-area cerebral infarction were divided into MCA-type and MCA-type with blood supply. The bedside transcranial color Doppler (TCD) was used on the day of admission and once every other day and on the 14th day The status of intracranial blood flow was detected dynamically. The changes of intracranial hemodynamics were observed by measuring the velocity of cerebral artery, pulsatility index and RVACA. Results The average blood flow velocity (Vm) and the average blood flow velocity of internal carotid artery (ICA) were significantly lower in MCA group than those in control group (P <0.05) The blood flow velocity of MCA was obviously slowed down in model group. The dynamic changes of MCA blood flow in MCA and MCA cortex were not obvious. NIHSS score and Pi were significantly higher than those on the 1st, 3rd and 7th day (P <0.05) ), NIHSS score the most obvious change. Conclusions The patients with large area cerebral infarction can detect the dynamic changes of bedside TCD and find out the collateral circulation compensatory and recanalization in time to evaluate the dynamic changes of intracranial pressure. Combined with neurological deficit score, the response to dehydration and intracranial pressure was observed. Select the appropriate treatment to provide the basis.