经颅多普勒检测破裂脑动脉瘤栓塞术后脑血管痉挛的临床应用

摘要

Objective To investigate the application value of transcranial Doppler(TCD) in the diagnosis of cerebral vasospasm (CVS) following cerebral aneurysm embolization.Methods From May 2013 to August 2016,46 patients with ruptured aneurysm of the brain were treated with arterial embolization in our hospital.All patients underwent TCD examination to detect the middle cerebral artery (MCA) blood flow velocity and the arterial inflow velocity (eICA) of the internal carotid artery,so as to determine whether the cerebral vasospasm occurred or not.DSA was used to compare the sensitivity and specificity of TCD in the diagnosis of cerebral vasospasm.Results The postoperative blood flow rate of MCA increased significantly since the third day.After operation,10d decreased gradually,but compared with before operation, the difference was significant (P<0.05).24 cases of CVS were diagnosed by DSA examination,Non CVS patients were 22 cases,The blood flow velocity of MCA in CVS patients was significantly higher than that in non CVS patients (P<0.05) after 3D.The DSA test results are used as the gold standard.At the same time with MCA blood flow rate>120cm/s as a criterion for vasospasm in TCD.The sensitivity,specificity,positive predictive value and negative predictive value of TCD for diagnosis of CVS was 9.17%,90.91%,90.48% and 80.00%,respectively.Conclusion TCD can early detect the occurrence of CVS after embolization of aneurysms,It has high sensitivity and specificity, which was worthy of further study.%目的 探讨经颅多普勒(TCD)在破裂脑动脉瘤栓塞术后脑血管痉挛(CVS)诊断中的应用价值.方法 2013年5月~2016年8月在我院接受动脉瘤栓塞术治疗的46例脑动脉瘤破裂患者,在手术前、后行TCD检查,探测大脑中动脉(MCA)血流速度和颈内动脉入颅段(eICA)的血流速度;以此为依据判断脑血管痉挛发生与否.以DSA为金标准比较TCD诊断脑血管痉挛的敏感度和特异性.结果 术后3 d起,患者MCA血流速度显著上升,术后10 d时逐渐下降,但与术前相比差异均有统计学意义(均P<0.05);术后3~7 d,患者eICA血流速度明显下降,与术前比较差均有统计学意义(均P<0.05).经DSA检查确诊CVS患者24例,非CVS患者22例.术后3 d起,CVS患者MCA血流速度均显著高于非CVS患者(均P<0.05).以DSA检查结果作为金标准,同时以MCA血流速度>120 cm/s作为TCD法血管痉挛判断标准,TCD诊断CVS的敏感度为79.2%,特异度为90.9%,阳性预测值为90.5%,阴性预测值为80.0%.24例CVS患者经尼莫同治疗后病情均好转,无死亡病例.结论 TCD能够在早期发现破裂动脉瘤栓塞术后CVS的发生,具有较高的敏感度和特异度;值得进一步在临床应用.