Boecher-Schwarz H G, Fries G, Mueller-Forell W, Kessel G, Perneczky A
Department of Neurosurgery, Johannes Gutenberg University, Mainz, Germany.
Acta Neurochir (Wien). 1998;140(6):573-8. doi: 10.1007/s007010050142.
In 72 patients with acute subarachnoid haemorrhage (SAH) the relationship between the amount of subarachnoid blood clots detected by initial cranial computed tomography (CCT) up to 48 hours after bleeding and the later development of vasospasm, established by blood flow velocity measurement with transcranial Doppler ultrasound (TCD) was investigated. The serial Doppler examinations started within the first 72 hours after SAH and were carried out every second day up to three weeks. Each Doppler recording was accompanied by a neurological examination. Patients classified as Hunt and Hess grade V were excluded from the study. All patients with remarkable brain oedema in CCT or with intracranial pressure above 25 mmHg were also excluded. Because of the well known age-dependence of vasospasm after SAH, two age groups were formed. A statistically significant correlation (p > 0.05) between blood flow velocities and blood load after SAH was not found. The mean age of the investigated 72 individuals was 48.9 years (14 up to 76 years). 47 patients were younger than 56 years. Linear regression analysis indicated a correlation with a quite low significance level (r = 0.350, p < 0.025) between TCD blood flow velocities and blood load in CCT in these younger subjects. No significant correlation (p > 0.05) between these two variables could be established in the 25 patients older than 55 years. In a second step an intra-individual comparison of side-to-side differences in TCD and CCT was made. There were no significant differences in blood flow velocities between subjects with or without side-to-side differences in cisternal blood load. It is concluded that the amount of blood visible on initial CCT after SAH is not a powerful predictor of cerebral blood flow velocities measured by TCD.
在72例急性蛛网膜下腔出血（SAH）患者中，研究了出血后48小时内通过首次头颅计算机断层扫描（CCT）检测到的蛛网膜下腔血凝块数量与后期血管痉挛发展之间的关系，血管痉挛通过经颅多普勒超声（TCD）测量血流速度来确定。系列多普勒检查在SAH后的头72小时内开始，每两天进行一次，直至三周。每次多普勒记录都伴有神经学检查。Hunt和Hess分级为V级的患者被排除在研究之外。所有在CCT中显示明显脑水肿或颅内压高于25 mmHg的患者也被排除。由于SAH后血管痉挛众所周知的年龄依赖性，形成了两个年龄组。未发现SAH后血流速度与血凝块负荷之间存在统计学显著相关性（p>0.05）。所研究的72名个体的平均年龄为48.9岁（14至76岁）。47名患者年龄小于56岁。线性回归分析表明，在这些较年轻的受试者中，TCD血流速度与CCT中的血凝块负荷之间存在相关性，显著性水平相当低（r = 0.350，p < 0.025）。在25名年龄大于55岁的患者中，这两个变量之间未发现显著相关性（p>0.05）。第二步，对TCD和CCT的左右差异进行个体内比较。脑池内血凝块负荷有或无左右差异的受试者之间，血流速度无显著差异。得出的结论是，SAH后首次CCT上可见的血量不是通过TCD测量的脑血流速度的有力预测指标。
