Transcranial Doppler sonography in adult hydrocephalic patients
Transcranial Doppler sonography in adult hydrocephalic patients
复制标题
成人脑积水患者的经颅多普勒超声检查
DOI：
10.1007/s101430050029
复制
发表时间：
2000
影响因子：
2.8
通讯作者：
Winfried Burkert
中科院分区：
文献类型：
--
作者：
Nikolai G. Rainov;Jan B. Weise;Winfried Burkert
经颅多普勒超声（TCD）是一种无创性检测Willis环主要动脉血流速度（CBFV）的技术。根据TCD数据计算的脉动指数（PI）和阻力指数（RI）的动态变化可评估作用于大脑末端血管系统的力。本研究旨在探讨成人高血压脑积水患者TCD参数与颅内压（ICP）变化之间的可能关系。应用经颅多普勒（TCD）对29例脑积水患者和20例健康对照者大脑中动脉（MCA）血流速度进行了研究。脑积水组在脑室腹腔分流术前测量颅内压，并与TCD数据进行相关性分析，脑积水组在脑室腹腔分流术前的平均CBFV明显低于对照组。与正常人相比，患者的收缩期和舒张末期CBFV值显著降低，提示远端脑血管阻力增加。与正常人相比，分流术前ICP升高的患者的PI和RI值显著增加。脑积水患者颅内压（ICP）与RI值呈显著正相关（r=0.50，P<0.01），PI与ICP、CBFV与ICP无显著相关性。颅内压（ICP）在分流后即刻恢复正常，PI和RI值显著下降，而平均CBFV增加。在一个亚组中，颅内压（ICP）值>35 mm Hg（n=6）的脑积水患者，上述变化比颅内压（ICP）值<35 mm Hg的亚组更明显，这表明ICP对TCD参数的影响呈指数级。TCD可以提供一个工具来评估颅内压的成年患者闭塞性脑积水，虽然一个准确的无创测量颅内压TCD似乎是不可能的。RI和PI指数的变化似乎是ICP升高的有用指标。
Abstract Transcranial Doppler sonography (TCD) is a noninvasive technique for measurement of cerebral blood flow velocity (CBFV) in the major arteries of the circle of Willis. Dynamic changes in the pulsatility index (PI) and the resistance index (RI), as calculated from TCD data, allow for an assessment of the forces acting on the terminal vasculature of the brain. The present study was designed to investigate a possible relationship between TCD parameters and intracranial pressure (ICP) changes in adult patients with hypertensive hydrocephalus. Blood flow velocity in the middle cerebral artery (MCA) was studied by TCD in 29 hydrocephalus patients and in 20 healthy controls. ICP was measured in the patient group before ventricular shunting and was correlated with TCD data.The mean CBFV in hydrocephalic patients prior to ventriculoperitoneal shunting was significantly lower than in the control group. Compared to normal persons, systolic and end-diastolic CBFV values in patients were significantly decreased, suggesting an increased distal cerebrovascular resistance. PI and RI values in patients with elevated ICP prior to shunting were significantly increased in comparison to those of normal persons. There was a statistically significant positive correlation of preshunting ICP and mean preshunting values of RI (r=0.50, P<0.01) in hydrocephalic patients, but no significant correlation between PI and ICP, and between CBFV and ICP. Immediately after shunting, ICP returned to normal, and PI and RI values decreased significantly, while the mean CBFV increased.In a subgroup of hydrocephalic patients with a preshunting ICP value >35 mm Hg (n=6), the changes described above were more pronounced than in the subgroup with preshunting ICP values <35 mm Hg, which suggests an exponential degree of influence of ICP on TCD parameters.In conclusion, TCD may provide a tool for assessment of ICP in adult patients with occlusive hydrocephalus, although an exact noninvasive measurement of ICP by TCD seems impossible. Changes in the RI and PI indices appear to be useful indicators of elevated ICP.