Trofimov Alex, Dobrzeniecki Michael, Bragin Denis E
Department of Neurosurgery, Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia.
Department of Polytrauma, Regional Hospital Named After N.A. Semashko, Nizhny Novgorod, Russia.
Acta Neurochir Suppl. 2020;127:185-190. doi: 10.1007/978-3-030-04615-6_29.
The purpose was to determine the status of the cerebral arterial compliance (cAC) in a concomitant head injury and cerebral vasospasm (CVS) with and without the development of intracranial hematomas (ICH). In Materials and Methods, we examined 80 polytrauma patients with severe TBI and CVS. During or immediately after dynamic helical computed tomography angiography (DHCTA), the monitoring of the transcranial Doppler of the MCA was recorded bilaterally with 2-MHz probes. The cerebral blood volumes were calculated from the DHCTA data with complex mathematical procedures using the "direct flow model" algorithm. In Results, CAC was significantly decreased (p < 0.001) in both the first and second group TBI and CVS (with or without ICH) in comparison with normal data (p < 0.001) and TBI without CVS. The cAC was significantly decreased on the side of the former hematoma with CVS than on the contralateral side with CVS (р = 0.003). In Conclusion, the cAC in TBI and CVS gets significantly lower as compared to the normal condition (p < 0.001). After removal of the ICH and development of CVS, the compliance in the perifocal zone remains much lower (р = 0.003) as compared to compliance of the other brain hemisphere.
目的是确定伴有或不伴有颅内血肿(ICH)形成的头部损伤合并脑血管痉挛(CVS)时脑动脉顺应性(cAC)的状态。在材料与方法中,我们检查了80例患有严重创伤性脑损伤(TBI)和CVS的多发伤患者。在动态螺旋计算机断层血管造影(DHCTA)期间或之后立即使用2MHz探头双侧记录大脑中动脉的经颅多普勒监测。使用“直接血流模型”算法通过复杂的数学程序从DHCTA数据计算脑血容量。结果显示,与正常数据(p < 0.001)和无CVS的TBI相比,第一组和第二组TBI合并CVS(伴或不伴ICH)的cAC均显著降低(p < 0.001)。与对侧有CVS相比,有CVS的原血肿侧的cAC显著降低(р = 0.003)。结论是,与正常情况相比,TBI合并CVS时的cAC显著降低(p < 0.001)。在清除ICH并发生CVS后,与另一脑半球的顺应性相比,病灶周围区域的顺应性仍然低得多(р = 0.