脑损伤后脑血管痉挛的早期监测及对预后的影响

应用二维经颅彩色多普勒超声血流显像仪早期动态监测颅脑损伤患者 ,以及早发现脑血管痉挛 ( CVS)。对 1 6 2例颅脑损伤患者根据伤情 ,结合头颅 CT分为3组 :1轻中型无蛛网膜下腔出血 ( SAH)组 ;2轻中型伴 SAH组 ;3重型组。在伤后2 4h内、3d、1周和 2周 ,分别检查脑血管平均血流速度及大脑中动脉流速与同侧颈内动脉流速的比率。结果发现轻中型伴 SAH组 CVS发生率增高 ,病情恢复慢。重型组 CVS发生率亦高 ,且持续时间长 ,发生范围广。CVS伤后当天即可发生 ,高峰期为3～ 7d,持续期因伤情而异 ,一旦发生 CVS,可引起脑缺血 ,加重脑损害。提示颅脑损伤后要早期监测及早发现 CVS,并早期处理 ,以减轻脑损害。

TRAUMATIC CEREBRAL VASCULAR SPASM MONITOR AND MECHANISM INVESTIGATION

The head injury patients were monitored with transcranial Color Doppler Flow Imaging continuously after injury, so as to detect cerebral vascular spasm (CVS) as possible as early, and to observe its development that now to influence the prognosis of head injury.According to the seriousness of injury and CT scan of head ,162 cases were divided into 3 groups:Group 1.slight and moderate head injury with no subarachnoid haemorrhage (SAH).Group 2.Slight and moderate head injury with SAH;Group 3.Severe head injury.Within 24 h, in 3 and 14 day after injury, cerebral heamodynamics were measured by Transcranial Color Doppler Flow Imaging.The incidence of CVS in group 2 and group 3 were higher than that of group 1 significantly.CVS lasted longer and were more extensive in group 3 compared with the other 2 groups.CVS were appeared in group 2 and 3 easily, some patients happened at first day after injury.Once the CVS were produced,the brain damage will be aggravated .So it is important to monitor and treat the CVS after head injury.