Wessels Tiemo, Harrer Judith U, Jacke Christian, Janssens Uwe, Klötzsch Christof
Department of Neurology, Aachen University Hospital Aachen, Germany.
Ultrasound Med Biol. 2006 Dec;32(12):1845-51. doi: 10.1016/j.ultrasmedbio.2006.06.023.
The aim of the presented study was to estimate the prognostic value of transcranial Doppler sonography (TCD) for the prediction of clinical outcome of patients after cardiopulmonary resuscitation (CPR) on the basis of the measured flow velocity changes in the basal cerebral arteries. Thirty-nine patients (27 men, 12 women) aged 66 +/- 15 y (+/-SD) who had undergone CPR were involved. Serial TCD examinations of the intracranial arteries were performed 1.5, 4, 8, 16, 24 and 72 h after CPR. Plasma neuron specific enolase (NSE), ventilation parameters (pH, paO(2), paCO(2)) and hemodynamic parameters were registered. Seventeen patients (group 1) survived with moderate or without neurologic deficits. Twenty-two patients (group 2) either died (n = 21) within 9 +/- 14 days or remained in vegetative state (n = 1). NSE levels ranged from 9 to 29 microg/L in group 1 and from 22 to 1242 microg/L in group 2 (p < 0.05). Four and 72 h after CPR, peak systolic flow velocities in the middle cerebral artery (MCA) were significantly higher in group 1 than in group 2 (p < 0.05). Twenty-four h after CPR, peak systolic and diastolic flow velocities in the ACA and PCA were also significantly higher in group 1 than in group 2 (p < 0.05). At this time, patients of group 2 showed significantly higher resistance index-values (RI = (sys-dia)/sys) in the anterior cerebral artery (ACA) and the posterior cerebral artery (PCA) (p < 0.05). A high correlation between peak systolic blood flow velocity in the MCA and systemic systolic blood pressure was observed in group 2 early 4 to 16 h after CPR (r = +0.52 to + 0.81, p < 0.05), while there was no such correlation in group 1. Using serial TCD examinations, patients with severely disabling or fatal outcome could be identified within the first 24 h. Besides established clinical and laboratory parameters, postanoxic myoclonus and NSE, serial TCD examinations following CPR may be helpful to predict the clinical outcome, but further studies with a larger number of patients are necessary to approve this hypothesis.
本研究的目的是基于测量的脑基底动脉血流速度变化，评估经颅多普勒超声（TCD）对心肺复苏（CPR）后患者临床结局的预测价值。纳入了39例接受过CPR的患者（27例男性，12例女性），年龄66±15岁（±标准差）。在CPR后1.5、4、8、16、24和72小时对颅内动脉进行系列TCD检查。记录血浆神经元特异性烯醇化酶（NSE）、通气参数（pH、动脉血氧分压、动脉血二氧化碳分压）和血流动力学参数。17例患者（第1组）存活，无或有中度神经功能缺损。22例患者（第2组）在9±14天内死亡（21例）或处于植物状态（1例）。第1组NSE水平为9至29μg/L，第2组为22至1242μg/L（p<0.05）。CPR后4小时和72小时，第1组大脑中动脉（MCA）的收缩期峰值血流速度显著高于第2组（p<0.05）。CPR后24小时，第1组ACA和PCA的收缩期和舒张期峰值血流速度也显著高于第2组（p<0.05）。此时，第2组患者大脑前动脉（ACA）和大脑后动脉（PCA）的阻力指数值（RI =（收缩压-舒张压）/收缩压）显著更高（p<0.05）。在CPR后早期4至16小时，第2组MCA的收缩期峰值血流速度与体循环收缩压之间存在高度相关性（r = +0.52至+0.81，p<0.05），而第1组不存在这种相关性。通过系列TCD检查，可在最初24小时内识别出预后严重致残或致命的患者。除了既定的临床和实验室参数、缺氧后肌阵挛和NSE外，CPR后的系列TCD检查可能有助于预测临床结局，但需要更多患者的进一步研究来证实这一假设。
