Fülesdi Béla, Réka Kovács Katalin, Bereczki Dániel, Bágyi Péter, Fekete István, Csiba László
Department of Anesthesiology and Intensive Care, University of Debrecen Medical and Health Science Center, Debrecen, Hungary.
J Neuroimaging. 2014 Mar-Apr;24(2):124-30. doi: 10.1111/j.1552-6569.2012.00776.x. Epub 2013 Jan 14.
The hematoma volume is an important determinant of outcome and a predictor of clinical deterioration in patients with intracerebral hemorrhage (ICH). Our goal was to evaluate alterations in the cerebral circulation, in respect to hemorrhage and edema volume changes, using transcranial Doppler (TCD).
Twenty patients with acute supratentorial ICH were examined. Brain, hematoma, and edema volumes were calculated from CT scans performed at admission and 2 weeks later. Data were compared with those obtained from bilateral TCD recordings of the middle cerebral arteries.
During TCD examination, blood flow velocities did not change, cerebral perfusion pressure (CPP) and resistance area product (RAP) decreased (P = .006, P = .002) while cerebral blood flow index (CBFI) remained constant on the affected side. Although hemorrhage volume did not correlate with RAP in the acute phase, correlation was found in the subacute phase (r = -.44, P = .04).
TCD monitoring sensitively demonstrates the hemodynamic change caused by ICH but the severity of the changes does not correlate with the volume of the ICH in acute stage. The CPP, RAP, and CBFI values are more sensitive parameters than the absolute velocity values, therefore they contribute more to the understanding of hemodynamic changes developed after spontaneous ICH.
血肿体积是脑出血（ICH）患者预后的重要决定因素及临床病情恶化的预测指标。我们的目标是使用经颅多普勒（TCD）评估脑循环在出血及水肿体积变化方面的改变。
对20例急性幕上脑出血患者进行检查。根据入院时及2周后所做的CT扫描计算脑、血肿及水肿体积。将数据与从中脑动脉双侧TCD记录获得的数据进行比较。
在TCD检查期间，血流速度未改变，脑灌注压（CPP）和阻力面积乘积（RAP）降低（P = .006，P = .002），而患侧的脑血流指数（CBFI）保持恒定。虽然急性期血肿体积与RAP无相关性，但在亚急性期发现存在相关性（r = -.44，P = .04）。
TCD监测能敏感地显示ICH引起的血流动力学变化，但急性期变化的严重程度与ICH体积无关。CPP、RAP和CBFI值比绝对速度值更敏感，因此它们对理解自发性ICH后发生的血流动力学变化贡献更大。
