TCD在急性前循环闭塞机械取栓术后预测脑出血的价值
The Value of TCD in Predicting Intracerebral Hemorrhage after Acute Precirculatory Occlusion
DOI: 10.12677/ACM.2020.102022, PDF,   
作者: 卢国章：山东第一医科大学(山东省医学科学院)，山东 泰安；张利勇, 郝继恒, 王培健, 王继跃：山东省聊城市人民医院血管神经外科，山东 聊城
关键词: 急性前循环闭塞；经颅多普勒超声；血流动力学；Acute Precirculation Occlusion； Transcranial Doppler Ultrasound； Hemodynamics
摘要: 目的：探讨TCD对急性前循环闭塞机械取栓术后预测脑出血的应用价值。方法：搜集2017.11~2018.12于聊城市脑科医院所有成功血管内再通治疗前循环血管闭塞(脑梗死2b-3)的缺血性卒中患者。我们回顾了他们介入后对侧和术侧大脑中动脉(MCA)平均血流速度指数(MBF)的TCD检查，并分析其与介入后脑出血和临床结果的关系。结果：本研究共纳入急性前循环闭塞成功行机械取栓的患者44例，26例(59%)为男性患者，纳入的患者中有21例(48%)为大脑中闭塞，9例(20%)为颈内动脉闭塞，14例(32%)颈内动脉 + 大脑中动脉闭塞。所有患者在介入术后14.6 ± 4.7小时内行TCD检查，并在16.4 ± 5.8小时内行颅脑CT或MRI，其中有8例(18%)术后出现实质性脑出血，脑出血均出现在术侧。90天MRS中，有18例患者恢复良好(MRS 0-2)，26例患者患者预后不良(MRS 3-6)，4例患者最终死亡(MRS 6)。研究的患者中，急性卒中介入术后出血比非出血的患者入院NIHSS评分更高(P = 0.034)。出血与非出血患者在性别、年龄、高血压、糖尿病、吸烟、饮酒、再通时间上无统计学意义。在90天预后中，出血患者的预后更差(MRs 3-6, P = 0.011)。TCD检查中，在出血组和非出血组中，MBF的比较有统计学意义(1.45 vs. 1.06, P < 0.001)。结论：在前循环闭塞再通治疗后，MCA的MBF速度指数较高，提示介入后ICH的风险和预后较差。
Abstract: Objective: To investigate the value of TCD in predicting intracerebral hemorrhage after acute an-terior circulation occlusion. Methods: To collect all ischemic stroke patients with precirculatory vascular occlusion (2b-3 cerebral infarction) who were successfully treated with endovascular recanalization in Liaocheng Brain Hospital from November, 2017 to December, 2008. We reviewed their TCD examination of mean flow velocity index (MBF) in the contralateral and intraoperative middle cerebral artery (MCA) after intervention and analyzed its relationship with intracerebral hemorrhage and clinical outcomes after intervention. Results: a total of 44 patients were included in this study, 26 (59%) were male, 21 (48%) were middle cerebral occlusion, 9 (20%) were internal carotid artery occlusion, and 14 (32%) were internal carotid artery + middle cerebral artery occlusion. All patients underwent TCD examination within 14.6 ± 4.7 hours after the intervention, and underwent craniocerebral CT or MRI within 16.4 ± 5.8 hours. Among them, 8 patients (18%) had substantial intracerebral hemorrhage after the intervention, all of which occurred on the operative side. In 90 days of MRS, 18 patients recovered well (MRS 0-2), 26 patients had poor prognosis (MRS 3-6), and 4 patients died (MRS 6). Among the patients in the study, admission NIHSS score was higher for bleeding after acute stroke intervention than for non-bleeding patients (P = 0.034). There was no significant difference in gender, age, hypertension, diabetes, smoking, drinking and recanalization time between bleeding and non-bleeding patients. In the 90-day prognosis, patients with bleeding had a worse prognosis (MRs 3-6 P = 0.011). In the TCD test, the comparison of MBF between the bleeding group and the non-bleeding group was statistically significant (1.45 vs. 1.06 P < 0.001). Conclusion: MBF velocity index of MCA was higher after treatment of anterior circulation occlusive recanalization, suggesting a lower risk and prognosis of ICH after intervention.

文章引用：卢国章, 张利勇, 郝继恒, 王培健, 王继跃. TCD在急性前循环闭塞机械取栓术后预测脑出血的价值[J]. 临床医学进展, 2020, 10(2): 134-140. https://doi.org/10.12677/ACM.2020.102022

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