Meyer Philippe Gabriel, Ducrocq Sarah, Rackelbom Thibault, Orliaguet Gilles, Renier Dominique, Carli Pierre
Department of Pediatric Anesthesiology and Neuro Intensive Care Unit, Hôpital Necker Enfants Malades, Université Paris 5, 149 Rue de Sèvres, 75743, Paris, France.
Childs Nerv Syst. 2005 Feb;21(2):133-7. doi: 10.1007/s00381-004-1016-1. Epub 2004 Sep 2.
The objective was to evaluate cerebral hemodynamics in young children with acute subdural hematoma (SDH) and the impact of surgical treatment using transcranial Doppler (TCD).
The design was a prospective study of infants with SDH requiring surgical evacuation.
The setting was the neuro intensive care unit of a university hospital.
Indications for surgical evacuation were based upon clinical and radiological arguments. Surgery included emergency needle aspiration followed by external or/and internal shunting as required. A TCD evaluation was performed before needle aspiration, and after each surgical drainage procedure. It included a pressure provocation test to assess cerebral compliance. Preoperative and postoperative middle cerebral artery (MCA) velocities, Gosling pulsatility (PI) and Pourcelot resistivity (RI) indexes and compliance were compared with Student's t-test, or Fisher's exact test as indicated.
Out of 26 infants, 23 (88%) had injuries that had possibly been inflicted, and 3 had accidental injuries. Initial TCD evaluation demonstrated intracranial hypertension with decreased diastolic velocity, increased PI and RI, and decreased compliance. Surgical evacuation resulted in statistically significant improvement in cerebral hemodynamics (diastolic velocity: 17.2+/-10 cm/s vs. 31.1+/-10 cm/s, p<0.0015, PI: 2.5+/-1.3 vs. 1.4+/-0.8, p<0.002, RI: 0.8+/-0.2 vs. 0.6+/-0.1, p<0.005) in all but 3 infants, who eventually died. Surgical drainage (primary shunting or external drainage) was needed in 23 infants and resulted in further improvement in cerebral hemodynamics. Finally, 73% of the infants made a good recovery.
Children with acute bilateral HSD have a high incidence of increased intracranial pressure as assessed by TCD. Surgical evacuation improves cerebral hemodynamics. TCD could be used for assessing the need for, and the efficiency of surgical drainage.
评估急性硬膜下血肿（SDH）幼儿的脑血流动力学以及经颅多普勒（TCD）手术治疗的影响。
对需要手术清除血肿的SDH婴儿进行前瞻性研究。
大学医院的神经重症监护病房。
手术清除血肿的指征基于临床和影像学依据。手术包括紧急穿刺抽吸，必要时进行外部或/和内部分流。在穿刺抽吸前以及每次手术引流后进行TCD评估。评估包括压力激发试验以评估脑顺应性。术前和术后大脑中动脉（MCA）流速、戈斯林搏动指数（PI）和普尔塞洛阻力指数（RI）以及顺应性采用学生t检验或如所示的费舍尔精确检验进行比较。
26例婴儿中，23例（88%）有受虐可能，3例为意外伤害。初次TCD评估显示颅内高压，舒张期流速降低，PI和RI升高，顺应性降低。手术清除血肿使除3例最终死亡的婴儿外所有婴儿的脑血流动力学有统计学显著改善（舒张期流速：17.2±10 cm/s对31.1±10 cm/s，p<0.0015；PI：2.5±1.3对1.4±0.8，p<0.002；RI：0.8±0.2对0.6±0.1，p<0.005）。23例婴儿需要手术引流（初次分流或外部引流），这使脑血流动力学进一步改善。最终，73%的婴儿恢复良好。
通过TCD评估，急性双侧HSD儿童颅内压升高的发生率较高。手术清除血肿可改善脑血流动力学。TCD可用于评估手术引流的必要性和有效性。
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