经颅多普勒超声对重型颅脑损伤预后的预测作用及其与无反应性全轮廓评分的相关性

Amr El-Morsy, A. Dahroug, Ahmed Elfaham
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摘要

外伤性脑损伤(TBI)是一个重大的公共卫生问题。它被认为是全世界死亡和残疾的主要原因之一。脑外伤后,脑血流量(CBF)变得非常低,接近缺血阈值。同时,脑血流速度在损伤后与脑血流本身密切相关。当使用经颅多普勒(TCD)在损伤后立即测量时,这种血流动力学紊乱可用于预测严重TBI的预后。TCD可以无创地评估不同的CBF速度和脉搏指数(PI)。这些指标的异常测量被认为与不良结果有关。目的本研究的目的是评估早期TCD对严重TBI患者的预测价值,并将不同的TCD测量与无反应性(FOUR)评分的完整大纲相关联。根据格拉斯哥昏迷评分(GCS),共有74例严重TBI患者在创伤后24小时内接受了TCD治疗。记录大脑中动脉(MCA)速度、脉搏指数(PI)及其他临床和神经影像学数据,并将患者分为TCD测量正常组、灌注不足组和血管痉挛组。低灌注定义为满足三个标准中的两个:MCA平均流速小于35 cm/s, MCA舒张末期流速小于20 cm/s, PI大于1.4。血管痉挛定义为平均血流速度大于120cm /s。使用3个月时的格拉斯哥结局量表和住院死亡率来评估结果。TCD测量也与GCS和FOUR评分相关。结果PI与3个月时延长的格拉斯哥结局量表有显著相关性。PI与死亡率也有显著的相关性。PI与FOUR评分呈显著负相关。两组间灌注不足组GCS和FOUR评分最差,血管痉挛组急性生理和慢性健康评估II评分最差。结论:在创伤后24小时内测量PI,可以很好地预测3个月时的死亡率和功能结局。PI值与损伤严重程度呈中度负相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Role of transcranial Doppler ultrasound as a predictor of outcome in severe traumatic brain injury and its correlation with full outline of unresponsiveness score
Intro duction Traumatic brain injury (TBI) is a major public health problem. It is considered to be one of the leading causes of death and disability worldwide. After TBI, cerebral blood flow (CBF) becomes extremely low approaching ischemic thresholds. Concurrently, CBF velocities become strongly correlated to CBF itself post injury. Identification of such hemodynamic disturbances can be used to predict outcome in severe TBI when measured immediately postinjury using transcranial Doppler (TCD). TCD permits noninvasive assessment of different CBF velocities as well as pulsatility index (PI). Abnormal measurement of such indices is believed to correlate to poor outcome. Objective The aim of this work was to assess the predictive value of early TCD in patients with severe TBI and to correlate different TCD measurements with full outline of unresponsiveness (FOUR) score. Patients and methods In total, 74 patients with severe TBI, according to Glasgow Coma Scale (GCS), underwent TCD within 24 h posttrauma. Middle cerebral artery (MCA) velocities and pulsatility index (PI), as well as other clinical and neuroimaging data, were recorded and accordingly patients were divided into three groups: patients with normal TCD measurements, patients with hypoperfusion, and patients with vasospasm. Hypoperfusion was defined by meeting two out of three criteria: mean flow velocity of MCA less than 35 cm/s, end-diastolic velocity of MCA less than 20 cm/s, and PI more than 1.4. Vasospasm was defined as mean flow velocity more than 120 cm/s. Outcome was evaluated using the Glasgow Outcome Scale Extended at 3 months, as well as in-hospital mortality. TCD measurements were also correlated to GCS and FOUR score. Results There was a significant correlation between PI and Glasgow Outcome Scale Extended at 3 months. There was also significant correlation between PI and mortality. Strong negative correlation was recognized between PI and FOUR scores. Patients with hypoperfusion showed worst GCS and FOUR score and patients with vasospasm group showed worst Acute Physiology and Chronic Health Evaluation II score between all groups. Conclusion PI, when measured within the first 24 h posttrauma, is considered a good predictor of mortality as well as functional outcome at 3 months. PI values were associated with moderate negative correlation with the severity of injury FOUR score.
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