Kesav Praveen, Khurana Dheeraj, Prabhakar Sudesh K, Ahuja Chirag K, Khandelwal Niranjan
Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Neuroradiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Ann Indian Acad Neurol. 2019 Apr-Jun;22(2):195-198. doi: 10.4103/0972-2327.144277.
The data on the role of Transcranial Doppler (TCD) in the management of acute primary intracerebral hemorrhage (ICH) is meager.
To study TCD variables associated with hematoma expansion in acute primary ICH.
The study was carried out in the neurosciences department of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh from July 2010 to September 2011 employing a prospective, double blinded non randomized study design.
Acute ICH patients within 24 h of symptom onset were recruited. Baseline neuroimaging study (Computerized tomography, CT scan of brain) was performed to assess the pure hematoma volume by AXBXC/2 method. Baseline TCD parameters were obtained from both the middle cerebral arteries (MCAs; affected and unaffected hemisphere): Peak Systolic velocity, End Diastolic velocity, Mean Flow velocity, Resistance Index, and Pulsatility Index. Follow up (24 h) assessment of hematoma volume and TCD were carried out. Each of the TCD variables were compared in hematoma expansion (>33% increase in hematoma volume on the follow-up CT) and non-expansion group.
On univariate analysis, the Student's -test and contingency tables with the X test were used. A forward stepwise multivariate logistic regression analysis with hematoma expansion at 24 h as the dependent variable and ROC analysis was carried out, using SPSS software version 16 (Chicago, IL). value < 0.05 was considered significant.
Twenty-five patients completed the study. Ten patients (40%) had hematoma expansion. Multivariate analysis revealed unaffected hemisphere MCA Pulsatility Index ratio [unaffected hemisphere MCA Follow up Pulsatility Index/baseline Pulsatility Index] of > 1.055 as the lone correlate of hematoma expansion (sensitivity of 90% and specificity of 60%).
Frequent assessment with TCD could aid in prediction of hematoma expansion by measuring unaffected hemisphere Pulsatility Index ratios.
经颅多普勒（TCD）在急性原发性脑出血（ICH）管理中的作用的数据较少。
研究急性原发性ICH中与血肿扩大相关的TCD变量。
该研究于2010年7月至2011年9月在昌迪加尔医学教育与研究研究生学院（PGIMER）神经科学系进行，采用前瞻性、双盲非随机研究设计。
招募症状发作24小时内的急性ICH患者。进行基线神经影像学研究（计算机断层扫描，脑部CT扫描），通过AXBXC/2方法评估纯血肿体积。从双侧大脑中动脉（MCA；患侧和未患侧半球）获取基线TCD参数：收缩期峰值速度、舒张末期速度、平均流速、阻力指数和搏动指数。进行血肿体积和TCD的随访（24小时）评估。比较血肿扩大组（随访CT上血肿体积增加>33%）和非扩大组的每个TCD变量。
在单变量分析中，使用学生t检验和X检验的列联表。以24小时血肿扩大为因变量进行向前逐步多变量逻辑回归分析，并进行ROC分析，使用SPSS软件版本16（伊利诺伊州芝加哥）。P值<0.05被认为具有统计学意义。
25名患者完成了研究。10名患者（40%）出现血肿扩大。多变量分析显示，未患侧半球MCA搏动指数比值[未患侧半球MCA随访搏动指数/基线搏动指数]>1.055是血肿扩大的唯一相关因素（敏感性为90%，特异性为60%）。
通过测量未患侧半球搏动指数比值，TCD的频繁评估有助于预测血肿扩大。
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