目的 探讨经颅多普勒(TCD)监测在颅脑损伤后脑血管痉挛(CVS)中的应用.方法 回顾性分析64例颅脑损伤病人的临床资料,运用TCD连续监测脑血流变化.探讨病人GCS评分和改良Fisher分级与CVS的相关性.结果 本组出现不同程度CVS 19例(29.7％),伤后24 h内表现为脑血流速度增加,伤后3～5 d达高峰,随后逐渐下降.根据GCS评分,轻型、中型、重型颅脑损伤病人中CVS的发生率分别为23.5％、33.3％和83.3％,其CVS的发生率差异有统计学意义(P＜0.01).改良Fisher分级3级病人发生CVS的比例显著高于2级和4级病人(P＜0.05).结论 TCD连续监测可早期诊断CVS,并指导治疗,减少缺血性神经功能损害,改善预后.%Objective To investigate the application of transcranial Doppler (TCD) in detecting cerebral vasospasm (CVS) after brain injury. Methods Clinical data of 64 patients with brain injury were analyzed retrospectively. Change of blood flow was detected continuously by TCD. The correlation between GCS scores, modified Fisher scale and CVS were analyzed. Results CVS in different degrees occurred in 19 patients (29.7%). The cerebral blood flow increased 24 h after brain injury, CVS reached peak 3 to 5 d after injury and then decreased. According to GCS scores, the incidence rates of CVS in mild, moderate and sever brain injury were 23.5%, 33.3% and 83.3% respectively, and significant difference was found between the incidence rates of CVS in different degrees (P< 0.01). The incidence rates of CVS were obviously higher in the patients with modified Fisher grade Ⅲ than in the patients with grades Ⅱ and Ⅳ (P < 0.05). Conclusion Continuous TCD monitoring can early diagnose CVS, guide the treatment, reduce the ischemic neurological deficits and improve the prognosis.
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