经颅彩色多普勒超声评价脑中线移位对急性脑卒中患者转归的预测作用

摘要

目的 利用经颅彩色多普勒超声(TCCD)监测急性脑卒中患者脑中线移位的程度,并对不同程度脑中线移位患者预后进行分析评估.方法 选取2015年10月～2016年1月入住我院神经内科,应用TCCD监测脑中线移位患者58例,其中经头颅CT或MRI证实有脑中线移位的大面积脑梗死患者25例(脑梗死组)和脑出血患者33例(脑出血组),并进行统计学分析.结果 脑梗死组和脑出血组头颅CT/MRI与TCCD监测的脑中线移位值比较,差异无统计学意义[(3.32±2.43)mm vs (3.28±2.31)mm,P=0.986;(3.64±2.03)mmvs(3.43±1.90)mm,P=0.630].TCCD检测脑中线移位值与年龄、性别、血管危险因素及临床病情不相关(P＞0.05).TCCD检测脑中线移位的ROC曲线下面积0.961±0.008,特定界值1.75,敏感性100％％,特异性85.5％,准确性70.0％.结论 TCCD监测脑中线结构及移位有优势,为临床工作提供更方便(床旁)、可靠、无创的技术手段,为患者提供更经济的检查方法.%Objective To monitor the brain midline shift in acute ischemic stroke (AIS) patients by transcranial color coded duplex (TCCD) ultrasonography.Methods Fifty-eight patients with brain midline shift admitted to our hospital from October 2015 to January 2016 for TCCD ultrasonography were included in this study.Of these patients,25 with CT-or MRI-conformed massive ischemic stroke served as an ischemic stroke group and 33 with CT-or MRI-conformed cerebral hemorrhage served as a cerebral hemorrhage group.Their brain midline shift was statistically analyzed.Results No significant difference was found in brain midline shift monitored by CT/MRI and TCCD ultrasonography between the two groups (3.32±2.43 mm vs 3.28±2.31 mm,3.64± 2.03 mm vs 3.43± 1.90 mm,P＞0.05).TCCD ultrasonography showed that brain midline shift was not related with age,gender,vascular risk factors and clinical condition (P＞0.05),and showed that the area under the ROC curve for brain midline shift was 0.961±0.008,with a specific value of 1.75,a sensitivity of 100％,a specificity of 85.5％,and an accuracy of 70.0％.Conclusion TCCD ultrasonography has its advantages in monitoring brain midline structure and shift,and provides a more convenient,reliable,and noninvasive technique for clinians and a more economic examination method for patients.