经颅多普勒超声及微血管多勒普超声在检测动脉瘤破裂后血管痉挛中的应用
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摘要
目的探讨经颅多普勒超声(TCD)及微血管多勒普超声(MDU)在出血性动脉瘤治疗中的应用价值。方法选取保定市第二中心医院2015年10月~2017年5月出血性动脉瘤患者78例,根据就诊顺序编号,采取随机数字表法分为对照组与研究组,每组各39例。两组均采取开颅手术,动脉瘤夹闭前、后研究组采取MDU实施检测,对照组采取TCD实施检测,针对发生血管痉挛患者,参照探查情况调节动脉瘤夹位置。统计两组治疗情况(动脉瘤夹调整率、再手术率、住院时长)、并发症发生率、治疗前后日常生活能力(ADL)及生活质量(SF-36)分值、预后效果。结果研究组动脉瘤夹调整率(38.46%)高于对照组(17.95%),再手术率(5.13%)低于对照组(20.51%),住院时长短于对照组(P<0.05);研究组并发症发生率(10.26%)低于对照组(28.21%)(P<0.05);术后6个月两组ADL及SF-36分值较术前增高,且研究组高于对照组(P<0.05);研究组预后情况优于对照组(P<0.05)。结论出血性动脉瘤治疗过程中采取MDU实施监测,可及时发现术中夹闭不全或误夹等现象,并对动脉瘤夹位置予以及时调整,利于降低再手术率,缩短住院时间,减少术后并发症,促使患者日常生活能力及生活质量提高,且能改善患者近期预后效果。
Objective To investigate the application value of transcranial Doppler ultrasound(TCD) and microvascular Doppler ultrasound(MDU) in the treatment of hemorrhagic aneurysm. Methods A total of 78 patients with hemorrhagic aneurysm in the Second Central Hospital of Baoding City from October 2015 to May 2017 were selected and according to the order number, they were randomly divided into control group and study group, with 39 cases in each group. Both groups undertook craniotomy. Before and after aneurysm clipping, the study group was detected by MDU, and the control group was detected by TCD. For patients with vasospasm, the location of aneurysm clips was adjusted according to the situation of exploration. Before and after treatment, the treatment conditions(adjustment rate of aneurysm clip, reoperation rate, time of hospitalization), complication rate, activity of daily living(ADL) scores, quality of life(SF-36)scores and prognosis effect were statistically analyzed. Results The adjustment rate of aneurysm clips in the study group(38.46%) was higher than that in the control group(17.95%), the reoperation rate(5.13%) was lower than that in the control group(20.51%), and the time of hospitalization was shorter than that in the control group(P < 0.05). The incidence rate of complications in the study group(10.26%) was lower than that of the control group(28.21%)(P < 0.05).The scores of ADL and SF-36 in 6 months after operation were higher than those before operation, and the study group was higher than the control group(P < 0.05). The prognosis of the study group was better than that of the control group(P < 0.05). Conclusion The application of MDU in the treatment of hemorrhagic aneurysms is helpful to find the phenomenon of incomplete clipping or mistaken clips in the operation. Timely adjustment of the position of aneurysm clips can help to reduce the reoperation rate, shorten the hospitalization time, reduce the postoperative complications, improve the daily life ability and quality of life of patients, as well as the short-term prognosis.
Objective To investigate the application value of transcranial Doppler ultrasound(TCD) and microvascular Doppler ultrasound(MDU) in the treatment of hemorrhagic aneurysm. Methods A total of 78 patients with hemorrhagic aneurysm in the Second Central Hospital of Baoding City from October 2015 to May 2017 were selected and according to the order number, they were randomly divided into control group and study group, with 39 cases in each group. Both groups undertook craniotomy. Before and after aneurysm clipping, the study group was detected by MDU, and the control group was detected by TCD. For patients with vasospasm, the location of aneurysm clips was adjusted according to the situation of exploration. Before and after treatment, the treatment conditions(adjustment rate of aneurysm clip, reoperation rate, time of hospitalization), complication rate, activity of daily living(ADL) scores, quality of life(SF-36)scores and prognosis effect were statistically analyzed. Results The adjustment rate of aneurysm clips in the study group(38.46%) was higher than that in the control group(17.95%), the reoperation rate(5.13%) was lower than that in the control group(20.51%), and the time of hospitalization was shorter than that in the control group(P < 0.05). The incidence rate of complications in the study group(10.26%) was lower than that of the control group(28.21%)(P < 0.05).The scores of ADL and SF-36 in 6 months after operation were higher than those before operation, and the study group was higher than the control group(P < 0.05). The prognosis of the study group was better than that of the control group(P < 0.05). Conclusion The application of MDU in the treatment of hemorrhagic aneurysms is helpful to find the phenomenon of incomplete clipping or mistaken clips in the operation. Timely adjustment of the position of aneurysm clips can help to reduce the reoperation rate, shorten the hospitalization time, reduce the postoperative complications, improve the daily life ability and quality of life of patients, as well as the short-term prognosis.
引文
[1]胡新永,来海鸥,姬利,等.夹闭及栓塞治疗颅内动脉瘤对蛛网膜下腔出血患者脑血管痉挛及神经功能的影响[J].广西医科大学学报,2017,34(1):100-102.
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[4]李洪波,乐德玲.颅内动脉瘤夹闭术中多普勒超声监测的临床应用[J].临床外科杂志,2014,22(7):539-540.
[5]Cui H,Wang Y,Yin Y,et al.Role of intraoperative microvascular Doppler in the microsurgical management of intracranial aneurysms[J].J Clin Ultrasound,2011,39(1):27-31.
[6]曹慧,熊文峰,李卫萍,等.经颅彩色多普勒超声联合超声造影诊断颅内动脉瘤的价值[J].临床超声医学杂志,2015,17(2):88-90.
[7]张小征,莫雪红,马廉亭,等.彩色经颅多普勒超声在脑血管疾病中的应用[J].中国临床神经外科杂志,2012,17(6):325-327.
[8]Mracek J,譒tepanek D,Fiedler J,et al.The current technical possibilities of the peroperative safety advancement in the microsurgery of cerebral aneurysms-a review article[J].Rozhl Chir,2013,92(9):481-487.
[9]于远君.高压氧对脑动脉瘤术后患者生存能力及生存质量的影响研究[J].实用心脑肺血管病杂志,2013,21(3):63-64.
[10]时雷.开颅夹闭与血管介入栓塞术治疗脑动脉瘤患者的临床观察[J].心脑血管病防治,2016,16(3):205-207.
[11]李正伟,李军,冯雨,等.TCD监测颅内动脉瘤夹闭术后脑血管痉挛的临床分析[J].华中科技大学学报:医学版,2011,40(1):101-103.
[12]时飞,孙春明,刘建刚,等.小脑后下动脉瘤经微血管多普勒超声辅助下的显微外科治疗[J].现代生物医学进展,2013,13(22):4260-4262.
[13]Gruber A,Dorfer C,Standhardt H,et al.Prospective comparison of intraoperative vascular monitoring technologies during cerebral aneurysm surgery[J].Neurosurgery,2011,68(3):657-673.
[14]魏坤,张思迅,姚雪燕,等.微血管多普勒超声在颅内动脉瘤夹闭术中的应用[J].中日友好医院学报,2011,25(2):77-79,64.
[15]费智敏,张珏,书国伟,等.体感诱发电位和微血管多普勒超声在颅内动脉瘤夹闭术中的联合应用[J].上海交通大学学报:医学版,2011,31(12):1733-1736.
[16]Siasios I,Kapsalaki EZ,Kostas N.The role of intraoperative micro-Doppler ultrasound in verifying proper clip placement in intracranial aneurysm surgery[J].Neuroradiology,2012,54(10):1109-1118.
[17]莫雪红,华莎,张小征,等.彩色多普勒超声在颅内动脉瘤诊断中的应用价值[J].中国临床神经外科杂志,2010,15(6):336-338.
[18]陈景云,刘南平,周立明,等.62例颅内动脉瘤术中微血管多普勒监测的应用价值[J].宁夏医科大学学报,2011,33(8):756-757.
[19]李爱国,李志立,杨露曦,等.术中微血管超声多普勒在颅内动脉瘤夹闭术中的作用及疗效[J].重庆医学,2014,43(18):2272-2274,2277.
[20]梁日生,魏永,杨卫忠,等.神经电生理和微血管多普勒联合监测在颅内动脉瘤术中的应用研究[J].福建医科大学学报,2010,44(1):50-54.
[21]元少鹏,廖伟强,邓妙峰,等.动脉瘤性蛛网膜下腔出血后影响脑血管痉挛的原因分析及防治体会[J].中国医药科学,2018,8(10):202-204,223.
[22]茅磊,赵鑫,杭春华,等.微血管多普勒超声在颅内动脉瘤手术中的应用[J].中国脑血管病杂志,2016,13(9):460-464,488.
[23]吴毅,刘成辉,陈旭,等.血管内介入栓塞和开颅夹闭手术在颅内动脉瘤患者中的应用效果研究[J].中国医药科学,2018,8(7):213-216.
[24]Malinova V,von Eckardstein K,Rohde V,et al.Neuronavigated microvascular Doppler sonography for intraoperative monitoring of blood flow velocity changes during aneurysm surgery—A feasible monitoring technique[J].Clin Neurol Neurosurg,2015,137:79-82.
[2]Nakajima H,Kamiyama H,Nakamura T,et al.Direct surgical treatment of giant middle cerebral artery aneurysms using microvascular reconstruction techniques[J].Neurol Med Chir(Tokyo),2012,52(2):56-61.
[3]治娜,安媚,王宝艳,等.脑血管意外患者心理障碍的预见性护理[J].国际精神病学杂志,2016,43(3):516-518.
[4]李洪波,乐德玲.颅内动脉瘤夹闭术中多普勒超声监测的临床应用[J].临床外科杂志,2014,22(7):539-540.
[5]Cui H,Wang Y,Yin Y,et al.Role of intraoperative microvascular Doppler in the microsurgical management of intracranial aneurysms[J].J Clin Ultrasound,2011,39(1):27-31.
[6]曹慧,熊文峰,李卫萍,等.经颅彩色多普勒超声联合超声造影诊断颅内动脉瘤的价值[J].临床超声医学杂志,2015,17(2):88-90.
[7]张小征,莫雪红,马廉亭,等.彩色经颅多普勒超声在脑血管疾病中的应用[J].中国临床神经外科杂志,2012,17(6):325-327.
[8]Mracek J,譒tepanek D,Fiedler J,et al.The current technical possibilities of the peroperative safety advancement in the microsurgery of cerebral aneurysms-a review article[J].Rozhl Chir,2013,92(9):481-487.
[9]于远君.高压氧对脑动脉瘤术后患者生存能力及生存质量的影响研究[J].实用心脑肺血管病杂志,2013,21(3):63-64.
[10]时雷.开颅夹闭与血管介入栓塞术治疗脑动脉瘤患者的临床观察[J].心脑血管病防治,2016,16(3):205-207.
[11]李正伟,李军,冯雨,等.TCD监测颅内动脉瘤夹闭术后脑血管痉挛的临床分析[J].华中科技大学学报:医学版,2011,40(1):101-103.
[12]时飞,孙春明,刘建刚,等.小脑后下动脉瘤经微血管多普勒超声辅助下的显微外科治疗[J].现代生物医学进展,2013,13(22):4260-4262.
[13]Gruber A,Dorfer C,Standhardt H,et al.Prospective comparison of intraoperative vascular monitoring technologies during cerebral aneurysm surgery[J].Neurosurgery,2011,68(3):657-673.
[14]魏坤,张思迅,姚雪燕,等.微血管多普勒超声在颅内动脉瘤夹闭术中的应用[J].中日友好医院学报,2011,25(2):77-79,64.
[15]费智敏,张珏,书国伟,等.体感诱发电位和微血管多普勒超声在颅内动脉瘤夹闭术中的联合应用[J].上海交通大学学报:医学版,2011,31(12):1733-1736.
[16]Siasios I,Kapsalaki EZ,Kostas N.The role of intraoperative micro-Doppler ultrasound in verifying proper clip placement in intracranial aneurysm surgery[J].Neuroradiology,2012,54(10):1109-1118.
[17]莫雪红,华莎,张小征,等.彩色多普勒超声在颅内动脉瘤诊断中的应用价值[J].中国临床神经外科杂志,2010,15(6):336-338.
[18]陈景云,刘南平,周立明,等.62例颅内动脉瘤术中微血管多普勒监测的应用价值[J].宁夏医科大学学报,2011,33(8):756-757.
[19]李爱国,李志立,杨露曦,等.术中微血管超声多普勒在颅内动脉瘤夹闭术中的作用及疗效[J].重庆医学,2014,43(18):2272-2274,2277.
[20]梁日生,魏永,杨卫忠,等.神经电生理和微血管多普勒联合监测在颅内动脉瘤术中的应用研究[J].福建医科大学学报,2010,44(1):50-54.
[21]元少鹏,廖伟强,邓妙峰,等.动脉瘤性蛛网膜下腔出血后影响脑血管痉挛的原因分析及防治体会[J].中国医药科学,2018,8(10):202-204,223.
[22]茅磊,赵鑫,杭春华,等.微血管多普勒超声在颅内动脉瘤手术中的应用[J].中国脑血管病杂志,2016,13(9):460-464,488.
[23]吴毅,刘成辉,陈旭,等.血管内介入栓塞和开颅夹闭手术在颅内动脉瘤患者中的应用效果研究[J].中国医药科学,2018,8(7):213-216.
[24]Malinova V,von Eckardstein K,Rohde V,et al.Neuronavigated microvascular Doppler sonography for intraoperative monitoring of blood flow velocity changes during aneurysm surgery—A feasible monitoring technique[J].Clin Neurol Neurosurg,2015,137:79-82.