Jarus-Dziedzic K, Zub W, Wronski J, Juniewicz H, Kasper E
Department of Neurosurgery, Medical Research Center, Polish Academy of Sciences, Warsaw.
Acta Neurochir (Wien). 2000;142(3):309-18. doi: 10.1007/s007010050040.
127 patients with aneurysmal subarachnoid haemorrhage (SAH) were analyzed for the relationship between the amount of blood clots as detected by initial computed tomography (CT) up to 48 hours after SAH and changes of blood flow velocities as measured using transcranial Doppler ultrasonography (TCD). All patients were operated on within 72 hours after SAH. Patients who presented with remarkable brain oedema or with pathological intracranial pressure (ICP) due to mass effects of a haematoma, and who were in a poor neurological condition classified according to Hunt-Hess as grade V were excluded from this study. Serial TCD examination of the middle cerebral arteries (MCA) and anterior cerebral arteries (ACA) started within 48 hours after SAH and were performed daily up to three weeks. A statistically significant correlation between blood load designated according to Fisher's grading as group CT I-CT IV and mean flow velocities (MFV) was found in groups CT I, II, and III. High values of MFV in MCA examinations were noted in patients with severe SAH (group CT III)--161 cm/s, and low values in patients without SAH (group CT I)--119 cm/s. Patients with haematocephalus and/or haematoma without a mass effect (group CT IV) had lower blood flow velocities than patients with severe SAH (group CT III) but values were higher than in patients without SAH (group CT I). The number of days for which MFV in the MCA was > 120 cm/s and was statistically (p < 0.05) correlated with the amount of blood clots as observed in the respective CT (in group CT I, II, and III). MFV values in the anterior cerebral artery (ACA) were lower than those obtained in the middle cerebral artery (MCA) in all groups. Statistically significant (p < 0.05) differences were noted between groups CT I and CT III (first and third week) and between groups CT I and CT IV (third week). If the SAH was extensive in the CT scan, pathological values of MFV > 90 cm/s were observed in ACA, and this was more pronounced in group CT III than in group CT IV. Blood flow velocities obtained via TCD were registered to compare side-to-side differences and particularly high differences were observed in patients with severe SAH. It is concluded that the amount of blood clots in the initial computed tomography after SAH is significantly correlated with cerebral blood flow velocity measurements by TCD.
对127例动脉瘤性蛛网膜下腔出血（SAH）患者进行分析，以研究SAH后48小时内通过初始计算机断层扫描（CT）检测到的血凝块数量与经颅多普勒超声检查（TCD）测量的血流速度变化之间的关系。所有患者均在SAH后72小时内接受手术。因血肿占位效应出现明显脑水肿或病理性颅内压（ICP），且根据Hunt-Hess分级为V级、神经功能状态较差的患者被排除在本研究之外。SAH后48小时内开始对大脑中动脉（MCA）和大脑前动脉（ACA）进行连续TCD检查，每天进行一次，持续三周。在CT I、II和III组中，根据Fisher分级指定的血容量与平均血流速度（MFV）之间存在统计学显著相关性。在严重SAH患者（CT III组）的MCA检查中，MFV值较高——161 cm/s，而在无SAH患者（CT I组）中较低——119 cm/s。有脑积血和/或无占位效应血肿的患者（CT IV组）的血流速度低于严重SAH患者（CT III组），但高于无SAH患者（CT I组）。MCA中MFV>120 cm/s的天数与相应CT中观察到的血凝块数量具有统计学相关性（p<0.05）（CT I、II和III组）。所有组中大脑前动脉（ACA）的MFV值均低于大脑中动脉（MCA）。在CT I组和CT III组（第一周和第三周）以及CT I组和CT IV组（第三周）之间观察到统计学显著差异（p<0.05）。如果CT扫描显示SAH范围广泛，则在ACA中观察到MFV的病理值>90 cm/s，且在CT III组中比CT IV组更明显。记录通过TCD获得的血流速度以比较左右差异，在严重SAH患者中观察到特别高的差异。得出结论，SAH后初始计算机断层扫描中的血凝块数量与TCD测量的脑血流速度显著相关。
