经颅多普勒波形在颅内动脉球囊反搏中的应用，用于蛛网膜下腔出血后血管痉挛的检测。

Transcranial Doppler Waveforms During Intra-aortic Balloon Pump Counterpulsation for Vasospasm Detection After Subarachnoid Hemorrhage.

机构信息

Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland.

Department of Neurosurgery, Columbia University Medical Center, New York, New York.

出版信息

Neurosurgery. 2018 Sep 1;83(3):416-421. doi: 10.1093/neuros/nyx405.

DOI:10.1093/neuros/nyx405

PMID:28973669

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6454792/

Abstract

BACKGROUND

Transcranial Doppler ultrasound is a standard screening tool for vasospasm after subarachnoid hemorrhage. Prevention of vasospasm-induced delayed cerebral ischemia after subarachnoid hemorrhage depends on optimization of cerebral perfusion pressure, which can be challenged by neurogenic stress cardiomyopathy. Intra-aortic balloon pumps have been utilized to augment cerebral perfusion, but they change the transcranial Doppler waveform, altering its interpretability for vasospasm screening.

OBJECTIVE

To assess the features of the transcranial Doppler waveform that correlate with vasospasm.

METHODS

We retrospectively reviewed cases of subarachnoid hemorrhage that underwent same-day transcranial Doppler ultrasound and angiography. Transcranial Doppler waveforms were assessed for mean velocity, peak systolic velocity, balloon pump-augmented diastolic velocity, and a novel feature, "delta velocity" (balloon pump-augmented velocity - systolic velocity). Relationship of flow velocity features to vasospasm was estimated by generalized estimating equation models using a Gaussian distribution and an exchangeable correlation structure.

RESULTS

There were 31 transcranial Doppler and angiography pairings (12 CT angiography/19 digital subtraction angiography) from 4 patients. Fourteen pairings had proximal vasospasm by angiography. Delta velocity was associated with proximal vasospasm (coefficient -6.8 [95% CI -9.8 to -3.8], P < .001). There was no significant correlation with proximal vasospasm for mean velocity (coefficient -13.0 [95% CI -29.3 to 3.4], P = .12), systolic velocity (coefficient -8.7 [95% CI -24.8 to 7.3], P = .29), or balloon pump-augmented velocity (coefficient -15.3 [95% CI -31.3 to 0.71], P = .06).

CONCLUSION

Delta velocity, a novel transcranial Doppler flow velocity feature, may reflect vasospasm in patients with subarachnoid hemorrhage and intra-aortic balloon pumps.

摘要

背景

经颅多普勒超声是蛛网膜下腔出血后血管痉挛的标准筛查工具。蛛网膜下腔出血后预防因血管痉挛导致的迟发性脑缺血依赖于脑灌注压的优化，而神经源性应激性心肌病可能会对其造成挑战。主动脉内球囊泵已被用于增加脑灌注，但它们会改变经颅多普勒的血流波形，从而影响其对血管痉挛筛查的解读。

目的

评估与血管痉挛相关的经颅多普勒血流波形特征。

方法

我们回顾性分析了同日行经颅多普勒超声和血管造影的蛛网膜下腔出血病例。评估经颅多普勒血流波形的平均速度、收缩期峰值速度、球囊泵增强舒张速度和一个新特征“速度差”（球囊泵增强速度-收缩期速度）。使用广义估计方程模型，采用高斯分布和可交换相关结构，估计血流速度特征与血管痉挛的关系。

结果

4 名患者的 31 对经颅多普勒和血管造影（12 例 CT 血管造影/19 例数字减影血管造影）中有 14 对存在近端血管痉挛。速度差与近端血管痉挛相关（系数-6.8[95%置信区间-9.8 至-3.8]，P<0.001）。平均速度（系数-13.0[95%置信区间-29.3 至 3.4]，P=0.12）、收缩期速度（系数-8.7[95%置信区间-24.8 至 7.3]，P=0.29）或球囊泵增强速度（系数-15.3[95%置信区间-31.3 至 0.71]，P=0.06）与近端血管痉挛均无显著相关性。