目的 探讨经颅多普勒超声(TCD)定量监测对预测蛛网膜下腔出血(SAH)后脑血管痉挛(CVS)患者不良预后的价值;方法 回顾性分析 50 例SAH后CVS患者近远期预后,记录患者TCD定量指标监测,Logistic回归分析近、远期不良预后独立危险因素,并绘制ROC曲线,构建不良预后风险评估模型;结果 第 1d 大脑中动脉血流速度(MCA-Vm)、第 3 d MCA-Vm和第 1d Lindegaard指数(LDGI)是SAH后CVS患者近期预后不良的独立危险因素;第 1 d MCA-Vm、第1 d LDGI是SAH后CVS患者远期预后不良的独立危险因素,近期预后风险评分=1.28×第1 d MCA-Vm+3.45×第 3d MCA-Vm+1.15×第 1 d LDGI,ROC曲线面积 0.851,最佳界值 11.20,灵敏度特异度分别为0.799和 0.812,远期预后风险评分=2.16×第 1d MCA-Vm+1.44×第 1 d LDGI,ROC曲线面积 0.719,最佳界值 8.48,灵敏度特异度分别为 0.844 和 0.469;结论 对于SAH后CVS患者要及早开展TCD监测,构建不良预后风险模型,预测其预后风险,分级处理和治疗患者,改善预后,值得推广.
Analysis of the Value of Transcranial Doppler Ultrasound Quantitative Index Monitoring in Predicting the Poor Prognosis of Patients with Cerebral Vasospasm after Subarachnoid Hemorrhage
Objective To investigate the value of transcranial Doppler ultrasound quantitative in-dex monitoring in predicting the poor prognosis of patients with cerebral vasospasm after sub-arachnoid hemorrhage.Methods The short-term and long-term prognosis of 50 patients with cerebral vasospasm after subarachnoid hemorrhage was analyzed retrospectively.The quantita-tive indicators of transcranial Doppler ultrasound were recorded.The independent risk factors of short-term and long-term poor prognosis were analyzed by Logistic regression.Results The 1 d MCA-Vm,3 d MCA-Vm and 1 d LDGI were independent risk factors for poor short-term prog-nosis in CVS patients after SAH,while the 1 d MCA-Vm and 1 d LDGI were independent risk factors for poor long-term prognosis in CVS patients after SAH.Near-term prognostic risk score =1.28×1d MCA-Vm+3.45×3d MCA-Vm+1.15×1d LDGI,ROC curve area was 0.851,optimal cut-off value was 11.20,sensitivity and specificity were 0.799 and 0.812,respectively.Long-term prognostic risk score=2.16×1d MCA-Vm+1.44×1d LDGI,ROC curve area was 0.719,opti-mal cut-off value was 8.48,sensitivity and specificity were 0.844 and 0.469,respectively.Conclu-sions For CVS patients after SAH,TCD monitoring should be carried out as early as possible,poor prognosis risk model should be constructed,prognosis risk should be predicted,graded treatment and prognosis should be improved.
transcranial Doppler ultrasoundmeasurement of cerebral vasospasm after sub-arachnoid hemorrhagepoor prognosis
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