本文選題：顱內(nèi)壓 + 經(jīng)顱多普勒�。� 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：目的： 對重度顱腦損傷患者的TCD頻譜圖像及參數(shù)特征進(jìn)行監(jiān)測,了解不同程度的顱內(nèi)高壓的頻譜圖像特征及其參數(shù),并與ICP監(jiān)測結(jié)果進(jìn)行對照分析,旨在探討TCD監(jiān)測顱腦損傷患者ICP的臨床應(yīng)用價值,為臨床應(yīng)用提供參考依據(jù)。 方法： 對進(jìn)行手術(shù)治療的48例顱腦外傷患者在手術(shù)結(jié)束時在顱內(nèi)放置微型傳感器探討,持續(xù)監(jiān)護患者的ICP。術(shù)后次日采用TCD技術(shù)經(jīng)患側(cè)顳窗獲取大腦中動脈(MCA)的超聲頻譜圖像,同時測量MCA的收縮期峰血流速度(Vs)、舒張期末血流速度(Vd)、平均血流速度(Vm)并計算搏動指數(shù)(PI)和阻力指數(shù)(RI),記錄即時的ICP值。根據(jù)患者ICP增高的程度進(jìn)行分組,分析比較各組患者的TCD頻譜圖像特征及參數(shù)改變情況。 結(jié)果： 1.轉(zhuǎn)歸：ICP正常組和ICP輕度增高組患者共25例,治愈19例,中度殘疾6例；12例ICP中度增高患者中,其中2例腦水腫腫脹進(jìn)行性加重,ICP持續(xù)升高而導(dǎo)致患者死亡,1例病情好轉(zhuǎn)后轉(zhuǎn)院,重度殘廢1例,3例中度致殘,余5例治愈出院；11例ICP重度增高患者中,其中死亡6例,自動出院1例,重度殘廢3例,中度殘廢1例。 2.頻譜圖像：與ICP正常組相比,ICP輕度增高組的頻譜圖像無明顯改變；ICP中度增高組的頻譜圖像顯示D峰前切跡加深；ICP重度增高組的頻譜圖像特征性改變?yōu)镾2峰消失和出現(xiàn)“單尖峰”,舒張期血流下降明顯。 3.TCD參數(shù)：舒張期末血流速度(Vd)、平均血流速度(Vm)隨著ICP的逐漸升高而呈現(xiàn)出下降趨勢。將各組數(shù)據(jù)分別與ICP正常組進(jìn)行比較,結(jié)果顯示ICP輕度增高組患者的Vd和Vm下降不明顯,差異無統(tǒng)計學(xué)意義(p0.05)；ICP中度增高組患者的Vd和Vm下降明顯,差異有統(tǒng)計學(xué)意義(p0.05)；ICP重度增高組患者的Vd和Vm下降最為顯著,具有顯著的統(tǒng)計學(xué)差異(p0.01)。PI和RI隨著ICP的逐漸升高而呈現(xiàn)出上升趨勢。ICP輕度增高組的各參數(shù)與ICP正常者相比,差異無統(tǒng)計學(xué)意義(pO.05),ICP中、重度增高組中參數(shù)PI、RI、Vd及Vm與ICP正常者相比,差異有統(tǒng)計學(xué)意義(p0.05)。 結(jié)論： ICP增高早期或輕度增高時,TCD頻譜圖像及參數(shù)無明顯改變。 TCD頻譜圖像中切跡加深可提示ICP已達(dá)到中度增高；而當(dāng)TCD頻譜表現(xiàn)為“單尖峰”和S2峰消失時,可提示ICP已達(dá)到重度增高； 與正常顱內(nèi)壓者相比,除收縮期峰血流速度(Vs)外,ICP中重度增高患者的TCD其他參數(shù)均有統(tǒng)計學(xué)差異； 與參數(shù)相比,TCD的頻譜圖像特征更能直觀反映顱腦損傷患者的ICP變化趨勢。
[Abstract]:Objective: to monitor the spectral images and parameters of TCD in patients with severe craniocerebral injury, to understand the characteristics and parameters of different degree of intracranial hypertension, and to compare the results with ICP. To explore the clinical application value of TCD monitoring ICP in patients with craniocerebral injury and to provide reference for clinical application. Methods: 48 patients with craniocerebral trauma were treated with microsensors at the end of operation. The next day after operation, the TCD technique was used to obtain the ultrasound spectrum of the middle cerebral artery (MCA) through the affected temporal window. At the same time, systolic peak blood flow velocity (VsN), end-diastolic flow velocity (VDV), mean blood flow velocity (Vm) of MCA were measured, pulsatility index (Pi) and resistance index (RI) were calculated, and ICP values were recorded. According to the degree of ICP elevation, the characteristics and parameters of TCD spectrum images were analyzed and compared. Results: 1. There were 25 cases in normal group and mild increase group of ICP, 19 cases were cured, 6 cases were moderate disability, 12 cases were moderately elevated ICP, Among them, 2 cases of brain edema swelling and progressive aggravation of ICP caused the death of 1 patient, 1 case of severe disability, 1 case of severe disability, 3 cases of moderate disability, the remaining 5 cases cured and discharged from hospital 11 cases with severe increase of ICP, among which 6 cases died. One case was discharged automatically, 3 cases were severely disabled and 1 case was moderately disabled. Spectrum image: compared with the normal ICP group, the frequency spectrum image of the mild elevated ICP group had no significant change, and the spectrum image of the moderate increased ICP group showed that the D peak pre-notch was deeper than that of the normal ICP group. The characteristic changes of spectrum image in the patients with severe ICP elevation were the disappearance of S2 peak and the appearance of "single spike". 3. TCD parameters: end diastolic velocity (VDX), mean blood flow velocity (Vm) showed a decreasing trend with the increase of ICP. The data of each group were compared with that of normal ICP group. The results showed that there was no significant decrease in VD and VM in patients with mild increase of ICP, but there was no significant difference in VD and VM in patients with moderate increase of ICP, and the difference was statistically significant (P 0.05). VD and VM decreased most significantly in patients with severe elevated ICP. There was significant statistical difference in Pi and RI with the increase of ICP. There was no significant difference in the parameters of patients with mild increase of ICP compared with that of patients with normal ICP, and there was no significant difference in ICP between the two groups. There was a significant difference in the parameters of Pi, RI, VD and VM between the patients with severe elevation and those with normal ICP (P 0.05). Conclusion: there is no significant change in TCD spectrum and parameters in the early stage or slightly elevated of ICP, and the deepening of the notch in TCD spectrum image may indicate that ICP has reached a moderate increase. However, when the TCD spectrum showed "single spike" and S2 peak disappeared, ICP had reached a severe increase, compared with that in normal intracranial pressure patients. The other parameters of TCD in patients with moderate and severe increase of ICP except systolic peak blood flow velocity (Vs) were statistically different, and compared with the parameters, the spectral features of TCD could directly reflect the trend of ICP in patients with craniocerebral injury.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R651.15

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