Müller M, Merkelbach S, Hermes M, Schimrigk K
Department of Neurology, University Hospital of the Saarland, Homburg/Saar, Germany.
Ultrasound Med Biol. 1996;22(2):173-8. doi: 10.1016/0301-5629(95)02029-2.
Transcranial Doppler sonography (TCD) of the middle, anterior and posterior cerebral arteries and of the basilar artery was used to evaluate the mean blood velocity (V mean) and the pulsatility index [PI = (V systolic-V diastolic)/V mean] as a vascular resistance index in 63 patients (male 40, female 23, mean age 43 +/- 19 y) with bacterial meningitis (n = 33, including 2 patients with fungal meningitis) and viral meningitis (n = 30) within 12 h after admission of the patients. The findings were similar for all intracranial arteries. Compared with reference values of 69 healthy volunteers [V mean of middle cerebral artery [MCA] 57 +/- 13 cm/s, MCA-PI 0.83 +/- 0.15], MCA-V mean was increased in patients with Glasgow coma scale (GCS) scores of 14 and 15 (71 +/- 18 cm/s; t-test: p < 0.001), not significantly different in the patients with GCS scores of 10-13 (55 +/- 21 cm/s) and decreased in those with GCS scores of 3-9 (42 +/- 21 cm/s, p < 0.01). The MCA-PI increased from 0.93 +/- 0.22 in the patients with GCS scores of 14-15 to 2.81 +/- 2.06 in those with GCS scores of 3-9 (p < 0.001 vs. controls). By regression analysis, MCA-V mean decreased and MCA-PI increased with decreasing GCS scores (p < 0.001). Only in patients with bacterial meningitis was the Glasgow outcome scale (GOS) score lower the more the MCA-PI was increased (regression analysis p < 0.001). We conclude that in patients with bacterial and viral meningitis, and in a good clinical state, the cerebral blood flow seems increased by hyperemia; with clinical deterioration the cerebral haemodynamics worsen. However, the early assessment of the cerebral blood flow by TCD seems useful for predicting outcome in bacterial meningitis only.
采用经颅多普勒超声（TCD）检测63例患者（男性40例，女性23例，平均年龄43±19岁）大脑中动脉、前动脉、后动脉及基底动脉的平均血流速度（V mean）和搏动指数[PI =（V收缩压-V舒张压）/V mean]作为血管阻力指数，这些患者在入院12小时内患有细菌性脑膜炎（n = 33，包括2例真菌性脑膜炎患者）和病毒性脑膜炎（n = 30）。所有颅内动脉的检测结果相似。与69名健康志愿者的参考值相比[大脑中动脉（MCA）的V mean为57±13 cm/s，MCA-PI为0.83±0.15]，格拉斯哥昏迷量表（GCS）评分为14和15的患者MCA-V mean升高（71±18 cm/s；t检验：p < 0.001），GCS评分为10 - 13的患者无显著差异（55±21 cm/s），GCS评分为3 - 9的患者则降低（42±21 cm/s，p < 0.01）。MCA-PI从GCS评分为14 - 15的患者的0.93±0.22升高至GCS评分为3 - 9的患者的2.81±2.06（与对照组相比p < 0.001）。通过回归分析，MCA-V mean随GCS评分降低而降低，MCA-PI随GCS评分降低而升高（p < 0.001）。仅在细菌性脑膜炎患者中，格拉斯哥预后量表（GOS）评分越低，MCA-PI升高越明显（回归分析p < 0.001）。我们得出结论，在细菌性和病毒性脑膜炎患者且临床状态良好时，脑血流似乎因充血而增加；随着临床病情恶化，脑血流动力学恶化。然而，TCD对脑血流的早期评估似乎仅对预测细菌性脑膜炎的预后有用。
