标题：创伤性脑损伤与自发性蛛网膜下腔出血所致脑血管痉挛的TCD临床对比观察

      作者：彭 涛 1.2，李定君 2，徐 宏 1，周增俊 1，李 政 1，吴小明 1，邹林波 1，陈 晨 1
    (1.德阳市人民医院神经外科，四川 德阳 618000；
2.泸州医学院第一附属医院神经外科，四川 泸州 646000)

      卷次： 2013年24卷24期

      【摘要】 目的 探讨经颅多普勒超声(TCD)对创伤性脑损伤(TBI)及自发性蛛网膜下腔出血(SAH)所致脑血
管痉挛(CVS)的诊断价值。方法 选择381例TBI和216例SAH患者，应用CT、CTA及TCD等确定患者的临床
诊断并筛选出存在CVS者，对TCD发现的CVS患者按血管痉挛程度（VmMCA值）分为轻、中、重三组。每天1次
行TCD监测。比较两组CVS发生率、开始时间、严重程度及持续时间。结果 381例TBI患者中共发生CVS 210
例，发生率为 55.12%；CVS发生在伤后 2~3 d，持续 10~14 d。而 216例 SAH患者 CVS发生 151例，发生率为
69.91%，发生时间在发病后 3~7 d，持续 14~21 d。两组CVS发生率、发病高峰及病程比较差异均有统计学意义
(P<0.01)。结论 TCD对CVS能准确进行临床诊断；创伤性脑损伤所致脑血管痉挛发生率低于自发性蛛网膜下
腔出血脑血管痉挛，但发生时间早，发生程度轻，持续时间短，预后好。

      【关键词】 创伤性脑损伤；蛛网膜下腔出血；脑血管痉挛；经颅多普勒；诊断

      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2013）24—3644—03


Comparative study on the clinical effect of transcranial Doppler sonography in the diagnosis of cerebral
vasospasm caused by traumatic brain injuries and spontaneous subarachnoid hemorrhage.
PENG Tao 1.2, LI
Ding-Jun 2, XU Hong 1, ZHOU Zeng-jun 1, LI Zheng 1, WU Xiao-ming 1, ZHOU Lin-Bo 1, CHEN Chen 1. 1. Department
of Neurosurgery, People's Hospital of Deyang City, Deyang 618000, Sichuan, CHINA; 2. Department of Neurosurgery, the
Affiliated Hospital of Luzhou Medical University, Luzhou 646000, Sichuan, CHINA

【Abstract】 Objective To assess the clinical effect of transcranial Doppler sonography (TCD) in the diagno-
sis of cerebral vasospasm (CVS) caused by traumatic brain injuries (TBI) or spontaneous subarachnoid hemorrhage
(SAH). Methods Firstly, we did clinical diagnosis and screened out the patients of CVS from 381 patients of TBI
and 216 patients of SAH by application of CT, CTA, TCD, which were divided into three groups by degree of CVS
(value of VmMCA): mild group, moderate group and severe group. Secondly, all the patients of CVS were checked
with TCD once a day. At last, the dates of incidence, severity, beginning and duration time, was to deal by means of
analysis and contrast in the patients of CVS between the patients of TBI and those of SAH. Results A total of 210
patients developed cerebral vasospasm in the 381 patients of TBI, with the incidence of 55.12%. The cerebral vaso-
spasm generated principally at the time of posttraumatic 2 to 3 day, and lasted 10 to 14 days. Meanwhile, 151 patients
developed CVS in the 210 patients of SAH, with the incidence of 69.3%. The cerebral vasospasm generated 3 to 7
days after disease, lasted 14 to 21 days. There were significant differences between pick and course of CVS in the pa-
tients of TBI and those of SAH (P<0.01). Conclusion To use TCD to diagnose cerebral vasospasm is accurate. The
CVS in patients of TBI happens earlier, with less degree and shorter duration, compared with the patients of SAH.

      【Key words】 Traumatic brain injuries (TBI); Spontaneous subarachnoid hemorrhage (SAH); Cerebral vaso-
spasm (CVS); Transcranial Doppler sonography (TCD); Diagnosis
基金项目：德阳市级科研项目(编号：2012SZ043-10)