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目的:探讨重型颅脑损伤患者经颅多普勒(transcranial doppler,TCD)参数与颅内压(intracranialpressure,ICP)及脑灌注压(cerebral perfusion pressure,CPP)的关系。方法:应用TCD检测40例重型颅脑损伤患者入院后连续7 d的大脑中动脉收缩期峰血流速度(peak systolic velocity,Vs)、舒张期末血流速度(end diastolicvelocity,Vd)、平均血流速度(mean velocity,Vm)以及搏动指数(pulsatility index,PI)、阻力指数(resistance index,RI),同时记录ICP、CPP、平均动脉压(mean arterial pressure,MAP)。结果:ICP与Vs、Vd、Vm均呈负直线回归关系,ICP与RI呈正直线回归关系,而与PI呈正指数回归关系。CPP与Vs、Vd、Vm均呈正直线回归关系,CPP与RI呈负直线回归关系,而与PI呈负指数回归关系。其中PI的相关系数最大(rICP=0.809,rCPP=-0.828,P<0.001)。在20 mmHg≤ICP≤50 mmHg4、0 mmHg≤CPP≤70 mmHg范围内,PI与ICP、CPP也呈直线相关,且相关性更好(rICP=0.864,rCPP=-0.887,P<0.001)。结论:TCD参数能够定性或半定量地判断ICP和CPP的变化,应用TCD是无创监测ICP和CPP的方向。
Objective: To investigate the relationship between transcranial doppler (TCD) parameters and intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in patients with severe craniocerebral injury. Methods: TCD was used to detect peak systolic velocity (Vs), end diastolic velocity (Vd), average blood flow Mean velocity (Vm), pulsatility index (PI) and resistance index (RI) were recorded. Meanwhile ICP, CPP and mean arterial pressure (MAP) were recorded. Results: There was a negative linear regression between ICP and Vs, Vd and Vm, positive linear regression between ICP and RI, and positive exponential regression with PI. CPP and Vs, Vd, Vm showed a positive linear regression, CPP and RI showed a negative linear regression, and PI showed a negative exponential regression. Among them, PI had the highest correlation coefficient (rICP = 0.809, rCPP = -0.828, P <0.001). In the range of 20 mmHg≤ICP≤50 mmHg4,0 mmHg≤CPP≤70 mmHg, there was a linear correlation between PI and ICP and CPP (rICP = 0.864, rCPP = -0.887, P <0.001). Conclusion: The TCD parameters can be used to determine the changes of ICP and CPP qualitatively or semi-quantitatively. The application of TCD is the direction of non-invasive monitoring of ICP and CPP.