Fatima Nida, Shuaib Ashfaq, Chughtai Talat Saeed, Ayyad Ali, Saqqur Maher
Department of Neurosurgery, Hamad General Hospital, Doha, Qatar.
Department of Neurology, Hamad General Hospital, Doha, Qatar.
Asian J Neurosurg. 2019 Jul-Sep;14(3):626-633. doi: 10.4103/ajns.AJNS_42_19.
To evaluate whether transcranial Doppler (TCD) monitoring plays a role as a prognostic indicator, by being both a diagnostic as well as a monitoring tool for increased intracranial pressure and cerebral vasospasm (VSP), in traumatic brain injury (TBI). Electronic databases and gray literature (unpublished articles) were searched under different MeSH terms from 1990 to the present. Randomized control trials, case-control studies, and prospective cohort studies on TCD in TBI (>18 years old). Clinical outcome measures included Glasgow Coma Outcome Scale (GCOS) and Extended GCOS and mortality. Data were extracted to Review Manager Software. Twenty-five articles that met the inclusion criteria were retrieved and analyzed. Ultimately, five studies were included in our meta-analysis, which revealed that patients with TBI with abnormal TCD (mean flow velocity [MFV] >120 cm/sec or MFV <35 cm/sec and Pulsatility Index >1.2) have a >3-fold higher likelihood of having poor clinical outcome in comparison to patients with TBI and normal TCD monitoring (odds ratio [OR]: 3.87; 95% confidence interval [CI]: 2.97-5.04; < 0.00001). Subgroup analysis revealed that abnormal TCD has a 9-fold higher likelihood of mortality (OR: 9.96; 95% CI: 4.41-22.47; < 0.00001). Further, subgroup analysis based on TCD findings revealed that the presence of hypoperfusion on TCD (middle cerebral artery [MCA] <35 cm/s) is associated with a three-fold higher likelihood of having poor functional outcome (OR: 3.72; 95% CI: 1.97-7.0; < 0.0001). The presence of VSP (MCA >120 cm/s) is associated with three-fold higher likelihood of poor functional outcome (OR: 3.64; 95% CI: 1.55-8.52; = 0.003). TCD is an evolving diagnostic tool that might play a role in determining the prognosis of patients with TBI. Further prospective study is needed to prove the role of TCD in TBI.
为评估经颅多普勒（TCD）监测作为一种预后指标是否发挥作用，它既是诊断工具，也是监测创伤性脑损伤（TBI）患者颅内压升高和脑血管痉挛（VSP）的工具。从1990年至今，在不同的医学主题词下检索了电子数据库和灰色文献（未发表的文章）。纳入了关于TBI（年龄>18岁）中TCD的随机对照试验、病例对照研究和前瞻性队列研究。临床结局指标包括格拉斯哥昏迷结局量表（GCOS）、扩展GCOS和死亡率。数据提取至Review Manager软件。检索并分析了25篇符合纳入标准的文章。最终，五项研究纳入我们的荟萃分析，结果显示，与TCD监测正常的TBI患者相比，TCD异常（平均流速[MFV]>120 cm/秒或MFV<35 cm/秒且搏动指数>1.2）的TBI患者临床结局不良的可能性高出3倍以上（比值比[OR]：3.87；95%置信区间[CI]：2.97 - 5.04；P<0.00001）。亚组分析显示，TCD异常的患者死亡可能性高出9倍（OR：9.96；95% CI：4.41 - 22.47；P<(此处原文有误，推测应为P)<0.00001）。此外，基于TCD结果的亚组分析显示，TCD出现低灌注（大脑中动脉[MCA]<35 cm/s）与功能结局不良的可能性高出3倍相关（OR：3.72；95% CI：1.97 - 7.0；P<0.0001）。出现VSP（MCA>120 cm/s）与功能结局不良的可能性高出3倍相关（OR：3.64；95% CI：1.55 - 8.52；P = 0.003）。TCD是一种不断发展的诊断工具，可能在确定TBI患者的预后中发挥作用。需要进一步的前瞻性研究来证实TCD在TBI中的作用。
