蛛网膜下腔出血患者头痛发作时经颅多普勒超声监测指标变化的临床研究

康志新

[摘要] 目的 鑒别蛛网膜下腔出血（SAH）患者头痛发作的病因，为患者提供及时有效的治疗指导方案。 方法 回顾性分析2010年5月～2013年12月入住中国石油天然气中心医院神经内科SAH患者61例临床资料。利用颅多普勒超声（TCD）监测SAH患者入院和头痛发作时大脑中动脉（MCA）、大脑后动脉（PCA）、椎基底动脉系统（BA）血流速度的变化，其中，符合脑血管痉挛（CVS）者为A组，不符合CVS为B组，比较两组TCD监测指标及治疗效果。 结果 A组患者78例次（53.8%），与入院时相比患者头痛发作时MCA、PCA、BA平均血流速度均增加，差异有统计学意义（P < 0.05），考虑为CVS所致，且给予及时有效的治疗方案，病情均得到缓解。B组患者67例次（46.2%），头痛发作时MCA、PCA、BA平均血流速度与入院时相比差异无统计学意义（P > 0.05），其中50例次（75%）患者给予减轻脑水肿治疗病情得到有效缓解。 结论 SAH患者TCD监测数据的变化为CVS诊断提供可靠依据。TCD实时监测对发现和鉴别CVS、脑水肿有重要的临床价值。

[关键词] 蛛网膜下腔出血；脑血管痉挛；脑水肿；经颅多普勒超声；尼莫通；甘露醇

[中图分类号] R743.35 [文献标识码] A [文章编号] 1673-7210（2017）07（b）-0094-04

A clinical study on changes of transcranial Doppler in patients with subarachnoid hemorrhage during headache attack

KANG Zhixin

Department of Internal Medicine， China Aviation Hospital， Beijing 100012， China

[Abstract] Objective To identify the etiology of headache in patients with subarachnoid hemorrhage， in order to provide timely and effective treatment guidelines for patients. Methods The clinical data of 61 patients with subarachnoid hemorrhage treated in Neurology Department of CNPC Central Hospital from May 2010 to December 2013 were analyzed retrospectively. TCD was used to monitor the changes of MCA， PCA and BA blood flow velocity in patients with subarachnoid hemorrhage during hospitalization and headache attack. According to the results of TCD， patients were divided into two groups. Patients in group A were corresponded to cerebral vasospasm， patients in group B were not corresponded to cerebral vasospasm. The TCD indexes and treatment effect of the two groups were compared. Results There were 78 case-times （53.8%） in group A. The MCA， PCA and BA blood flow velocity of patients at headache attack were increased than at hospitalization in group A， the differences were statistically significant （P < 0.05）， and it was considered to be caused by cerebral vasospasm. All patients had remission after given timely and effective treatment. There were 67 case-times （46.2%） in group B. The differences of MCA， PCA and BA blood flow velocity between patients at hospitalization and headache attack in group B had no statistically significant （P > 0.05）， and it was unrelated to cerebral vasospasm. 50 case-times （75%） of patients had remission after given alleviate cerebral edema treatment. Conclusion The changes of TCD monitoring data of SAH patients provide reliable evidences for cerebral vasopasm diagnosis. TCD real-time monitoring has important clinical value for finding and identifying cerebral vasopasm and cerebral edmema.

[Key words] Subarachnoid hemorrhage； Cerebral vasospasm； Brain edema； Transcranial Doppler； Nim； Mannitol

蛛网膜下腔出血（subarachnoid hemorrhage，SAH）通常指脑底部或脑表面的血管破裂后血液进入蛛网膜下腔所导致的一种临床综合征，是神经科常见的危重症之一，病死率高。头痛是SAH最常见的临床症状，发生率达85%～95%[1-3]。脑血管痉挛（cerebral vasopasm，CVS）、脑水肿是SAH后早期的最严重并发症，是SAH后残废和死亡的主要原因之一[4]。CVS和脑水肿常见的临床症状为难以忍受的剧烈头痛，而目前对于SAH患者头痛发作时的真正病因，尚无积极、有效、无创的判定手段。本研究采用经颅多普勒超声（transcranial doppler，TCD）实时监测SAH患者头痛发作时颅内大动脉血流速度，从而间接判断导致头痛的真正原因，为制订有效的治疗方案提供更多实验数据。……