Sander D, Klingelhöfer J
Department of Neurology, Technical University of Munich, Germany.
J Neurol Sci. 1993 Oct;119(1):1-7. doi: 10.1016/0022-510x(93)90185-2.
We studied the incidence and time course of flow velocity changes suggesting a vasospasm following post-traumatic subarachnoid hemorrhage (SAH) considering the intracranial pressure (ICP) in 38 SAH patients as compared to 30 patients with spontaneous SAH. The first investigation was done within 24 h after onset of hemorrhage and regularly followed up during the clinical course. Additionally, the index of cerebral circulatory resistance was calculated and the ICP was measured using an epidural transducer. A significant correlation between middle cerebral artery maximum mean flow velocity and the quantity of blood seen on a computed tomographic scan in patients with post-traumatic SAH indicates a similar pathogenetic mechanism of the development of vasospasm to that after spontaneous SAH. In contrast, there was a significantly earlier occurrence of mean flow velocities over 120 cm/s following post-traumatic SAH irrespective of the ICP. Therefore, additional factors must be considered in the evaluation of these pathologically raised flow velocities after posttraumatic SAH. In both SAH groups there was a highly significant correlation between clinical outcome and clinical grade on admission, ICP and resistance index. The weak correlation between maximum mean flow velocity and clinical outcome following post-traumatic SAH supports the notion that final clinical outcome of these patients is of multifactorial origin.
我们研究了创伤性蛛网膜下腔出血（SAH）后提示血管痉挛的血流速度变化的发生率和时间过程，并将38例SAH患者的颅内压（ICP）与30例自发性SAH患者进行了比较。首次调查在出血发作后24小时内进行，并在临床过程中定期随访。此外，计算了脑循环阻力指数，并使用硬膜外传感器测量了ICP。创伤性SAH患者大脑中动脉最大平均血流速度与计算机断层扫描上所见血量之间的显著相关性表明，血管痉挛发展的发病机制与自发性SAH后相似。相比之下，创伤性SAH后平均血流速度超过120 cm/s的情况明显更早出现，与ICP无关。因此，在评估创伤性SAH后这些病理性升高的血流速度时，必须考虑其他因素。在两个SAH组中，临床结局与入院时的临床分级、ICP和阻力指数之间均存在高度显著的相关性。创伤性SAH后最大平均血流速度与临床结局之间的弱相关性支持了这些患者的最终临床结局是多因素起源的观点。
