Suppr超能文献

经颅多普勒监测在蛛网膜下腔出血后脑血管痉挛诊断中的作用。

Role of transcranial Doppler monitoring in the diagnosis of cerebral vasospasm after subarachnoid hemorrhage.

作者信息

Vora YY, Suarez-Almazor M, Steinke DE, Martin ML, Findlay JM

机构信息

Division of Neurosurgery, University of Alberta Hospital, Edmonton, Canada.

出版信息

Neurosurgery. 1999 Jun;44(6):1237-47; discussion 1247-8.

Abstract

OBJECTIVE

The purpose of this study was to determine the correlation between transcranial Doppler (TCD) velocities and angiographic vasospasm after aneurysmal subarachnoid hemorrhage. METHODS: In the first part of this study, patients were retrospectively reviewed to correlate middle cerebral artery absolute blood flow velocities with angiographic vasospasm. In the second part of the study, the middle cerebral artery/ipsilateral extracranial internal carotid artery velocity ratio (Lindegaard ratio) was prospectively correlated with angiographic vasospasm. Angiographic vasospasm was independently graded, by observers blinded to the TCD results, as either none, mild (less than one-third artery luminal narrowing), moderate (one-third to one-half narrowing), or severe (more than one-half narrowing). The sensitivity, specificity, likelihood ratios for positive and negative TCD results, positive and negative predictive values, and kappa and P values were calculated. RESULTS: One hundred one patients were analyzed in the first part of the study, and 44 patients were analyzed in the second part. Interobserver agreement regarding angiographic vasospasm was good (kappa = 0.86). Despite significant correlation between mean velocities and the degree of vasospasm, the clinical dependability of TCD velocities (evaluated using predictive values and likelihood ratios) was limited. The positive predictive value of velocities of > or =200 cm/s for moderate/severe angiographic vasospasm was 87% but that of lower velocities was approximately 50%. The negative predictive value of velocities of <120 cm/s was 94% but that of higher velocities was approximately 75%. Only the likelihood ratios for velocities of <120 or > or =200 cm/s were useful (likelihood ratio for negative result = 0.17, likelihood ratio for positive result = 16.39). Overall, 57% of patients exhibited maximum velocities in the indeterminate range between 120 and 199 cm/s. Lindegaard ratios did not improve the predictive value of TCD monitoring. CONCLUSION: For individual patients, only low or very high middle cerebral artery flow velocities (i.e., <120 or > or =200 cm/s) reliably predicted the absence or presence of clinically significant angiographic vasospasm. Intermediate velocities, which were observed for approximately one-half of the patients, were not dependable and should be interpreted with caution.

摘要

目的

本研究旨在确定动脉瘤性蛛网膜下腔出血后经颅多普勒(TCD)流速与血管造影血管痉挛之间的相关性。方法:在本研究的第一部分,对患者进行回顾性分析,以关联大脑中动脉绝对血流速度与血管造影血管痉挛情况。在研究的第二部分,前瞻性地将大脑中动脉/同侧颅外颈内动脉流速比值(林德加德比值)与血管造影血管痉挛相关联。由对TCD结果不知情的观察者独立对血管造影血管痉挛进行分级,分为无、轻度(动脉管腔狭窄小于三分之一)、中度(三分之一至二分之一狭窄)或重度(超过二分之一狭窄)。计算TCD结果的敏感性、特异性、阳性和阴性似然比、阳性和阴性预测值以及kappa值和P值。结果:研究的第一部分分析了101例患者,第二部分分析了44例患者。观察者之间关于血管造影血管痉挛的一致性良好(kappa = 0.86)。尽管平均流速与血管痉挛程度之间存在显著相关性,但TCD流速的临床可靠性(使用预测值和似然比评估)有限。对于中度/重度血管造影血管痉挛,流速≥200 cm/s的阳性预测值为87%,但较低流速的阳性预测值约为50%。流速<120 cm/s的阴性预测值为94%,但较高流速的阴性预测值约为75%。只有流速<120或≥200 cm/s的似然比有用(阴性结果似然比 = 0.17,阳性结果似然比 = 16.39)。总体而言,57%的患者最大流速处于120至199 cm/s的不确定范围内。林德加德比值并未提高TCD监测的预测价值。结论:对于个体患者,只有大脑中动脉低流速或非常高的流速(即<120或≥200 cm/s)能可靠地预测临床上显著的血管造影血管痉挛的有无。约一半患者观察到的中等流速不可靠,应谨慎解读。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验