摘要
目的 研究重型脑外伤后脑血管痉挛（ＣＶＳ） 发生发展及其与外伤性蛛网膜下腔出血（ＳＡＨ） 的关系。方法 对３０ 例重型脑外伤住院病人［入院时格拉斯哥昏迷记分（ＧＣＳ） ≤８］ 进行头颅ＣＴ 检查，根据Ｆｉｓｈｅｒ改良分级评估ＳＡＨ 程度，并于入院２４ ｈ 后，第３ ｄ、５ ｄ、７ ｄ、１０ ｄ 通过经颅多普勒（ＴＣＤ） 对双侧大脑中动脉（ ＭＣＡ） 及颈内动脉（ＩＣＡ）颅外段进行脑血流速度检测。结果 １３ 例病人为ＣＶＳ，其中轻度６ 例，中度５ 例，重度２ 例，最终发展为缺血性神经功能损伤；ＣＶＳ组病人ＭＣＡ 流速及Ｌｉｎｄｅｒｇａａｒｄ Ｉｎｄｅｘ 伤后即升高，伤后３ ～５ ｄ 达到高峰，随后逐渐回落，但仍高于正常；严重ＳＡＨ（Ｆｉｓｈｅｒ Ⅲ） 病人组中，重度ＣＶＳ发生率明显高于其他Ｆｉｓｈｅｒ 分级组；ＣＶＳ组与非ＣＶＳ组伤后ＧＣＳ之间未见异常。结论 ＣＶＳ是重型脑外伤后常见并发症，严重ＳＡＨ 亦可进一步增加ＣＶＳ严重程度，严重ＣＶＳ可造成脑缺血，影响预后。
Objective To investigate the development of posttraumatic CVS, its relationship with subarachnoid hemorrhage and influence on the prognosis. Methods Thirty patients having severe hand injury were admitted with GCS less than 8. All patients were examined by CT scanning. Cerebral blood flow velocities of bilateral MCA and extra cranial portion of ICA were monitored regularly by TCD, starting from the first 24 hours after head injury until day 10. Results Vasospasm, defined as Vm MCA≥120cm/s and ipsilateral Lindergaard index ≥3, was found in 13 patients. The time course of the velocities of MCA and Lindergaard Index of patients with CVS increased progressively after injury, reaching a maximum at day 5 and 7, and then maintained at high level, showing a significant difference between them and those without CVS. The rate of occurrence of severe CVS in patients with severe SAH was higher than those with no or mild SAH. There was no statistical difference of GCS found between them.Conclusions These findings demonstrate that delayed cerebral vasospasm is a frequent complication of severe hand injury and at least in some cases, may influence the prognosis.(Shanghai Med J, 2000,23∶16 18)
出处
《上海医学》
CAS
CSCD
北大核心
2000年第1期16-18,共3页
Shanghai Medical Journal
