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目的探讨颅内压(ICP)增高的经颅多普勒(TCD)诊断价值以及甘露醇的治疗作用。方法41例ICP增高患者进行TCD检查,其中15例进行甘露醇治疗前后TCD动态观察,并以12例健康者TCD动态观察做对照组。依据TCD血流动力学变化,分析ICP增高的TCD改变。结果(1)ICP增高患者TCD呈特征性的高阻频谱。其平均流速(Vm)、舒张末期流速(Vd)显著降低,博动指数(PI)显著增高,与对照组比较差异有显著性(P<0.05)。(2)静点甘露醇后两组受试者的收缩峰流速(Vs)、Vm和Vd均加快;但ICP增高者的TCD改变以Vd增高为主(P<0.05),同时伴PI值显著性降低(P<0.05),此作用在给药后120min仍较显著;而在对照组给药后120min此作用已基本消失,且PI值在给药前后无显著改变(P>0.05)。结论TCD可作为一种ICP增高的无创性诊断方法,并可监测ICP的动态变化。甘露醇试验可验证ICP增高的TCD诊断。
Objective To investigate the diagnostic value of transcranial Doppler (TCD) with increased intracranial pressure (ICP) and the therapeutic effect of mannitol. Methods TCD was performed in 41 patients with elevated ICP. Fifteen patients were examined with TCD before and after mannitol treatment. TCD was performed in 12 healthy controls. Based on TCD hemodynamic changes, analysis of ICP increased TCD changes. Results (1) TCD in patients with ICP increased characteristic high-impedance spectrum. The mean flow velocity (Vm), end-diastolic flow velocity (Vd) and PI were significantly lower than those of the control group (P <0.05). (2) The peak systolic velocity (Vs), Vm and Vd of the two groups of subjects after intravenous injection of mannitol increased rapidly; however, the increase of TCD was mainly increased by Vd (P <0.05), accompanied by the significant increase of PI (P <0.05). The effect was still significant at 120 min after administration. However, the effect disappeared at 120 min after administration in the control group, and there was no significant change in PI before and after administration (P> 0.05). Conclusion TCD can be used as a noninvasive diagnostic method for ICP and can monitor the dynamic changes of ICP. Mannitol test verifies elevated ICP diagnosis of TCD.