Deeg K H, Paul J, Rupprecht T, Harms D, Mang C
Kinderklinik und Poliklinik, Universität Erlangen-Nürnberg.
Monatsschr Kinderheilkd. 1988 Feb;136(2):85-94.
In 52 infants (weight: 3174 +/- 1165 g; gestational age: 41.3 +/- 6.5 weeks) with hydrocephalus pulsed doppler recordings were obtained in the anterior cerebral arteries. For comparison 52 healthy infants (weight: 3148 +/- 1118 g; gestational age: 40.6 +/- 5.7 weeks) were investigated. In all children the maximal systolic velocity, the end-systolic velocity, the end-diastolic velocity and the pulsatility-index were measured. In the healthy control group the maximal systolic velocity was 43 +/- 14 cm x s-1, the end-systolic velocity 20 +/- 8 cm x s-1, the end-diastolic velocity 11 +/- 5 cm x s-1 and the pulsatility index was 0.75 +/- 0.10. All 9 children with minimal ventricular dilation without progression showed normal flow profiles with normal flow velocities and pulsatility-index in the anterior cerebral arteries. 17 infants with moderate, slowly progressive ventricular enlargement showed significant increase of the maximal systolic velocity (60 +/- 27 cm x s-1) and the pulsatility-index PI (0.82 +/- 0.14). There was no difference in the end-systolic and end-diastolic velocities to the healthy control group. 26 children with marked and rapid progressive hydrocephalus showed significant decrease of the end-systolic and end-diastolic velocities and an increase in the pulsatility-index. The end-systolic velocity was 15 +/- 7 cm x s-1, the end-diastolic velocity was 4 +/- 7 cm x s-1 and the pulsatility-index measured 0.91 +/- 0.18. There was no difference in the maximal systolic velocity which measured 41 +/- 17 cm x s-1. All children with increased intracranial pressure showed a pathological flow profile with a decrease of diastolic forward flow. Absent or retrograde diastolic flow in rapid progressive hydrocephalus may lead to a decrease of brain perfusion resulting in hypoxemic ischemic brain lesions. After implantation of a ventriculo-atrial shunt an increase in the end-systolic and end-diastolic velocities and a decrease of the pulsatility-index could be shown. Shunt insufficiency can be shown early by a decrease in diastolic forward flow.
在52例脑积水婴儿（体重：3174±1165克；胎龄：41.3±6.5周）中，在前脑动脉进行了脉冲多普勒记录。为作比较，对52例健康婴儿（体重：3148±1118克；胎龄：40.6±5.7周）进行了研究。对所有儿童测量了最大收缩期速度、收缩末期速度、舒张末期速度和搏动指数。在健康对照组中，最大收缩期速度为43±14厘米/秒，收缩末期速度为20±8厘米/秒，舒张末期速度为11±5厘米/秒，搏动指数为0.75±0.10。所有9例脑室轻度扩张且无进展的儿童在前脑动脉中显示出正常的血流模式，血流速度和搏动指数正常。17例脑室中度、缓慢进行性扩大的婴儿显示最大收缩期速度（60±27厘米/秒）和搏动指数PI（0.82±0.14）显著增加。收缩末期和舒张末期速度与健康对照组无差异。26例明显且快速进展性脑积水的儿童显示收缩末期和舒张末期速度显著降低，搏动指数增加。收缩末期速度为15±7厘米/秒，舒张末期速度为4±7厘米/秒，搏动指数为0.91±0.18。最大收缩期速度为41±17厘米/秒，无差异。所有颅内压升高的儿童均显示病理性血流模式，舒张期正向血流减少。快速进展性脑积水时舒张期血流缺失或逆流可能导致脑灌注减少，从而导致低氧缺血性脑损伤。在植入脑室-心房分流术后，可显示收缩末期和舒张末期速度增加，搏动指数降低。分流不足可通过舒张期正向血流减少早期显示出来。
