The Application Of The Diagnosis Of Cerebral Vasospasm Following Subarachnoid Hemorrhage On Transcranial Doppler

Objective：Transcranial Doppler (TCD) diagnosis of the CVS followingSAH, explore the hemodynamic changes of the CVS following SAH, andprovide the basis for determining the timing of surgery and to guide clinicalinterventions.Materials and Methods: Collect the First Department of Neurosurgery ofChina-Japan Union Hospital of Jilin University January2011to February2012surgical treatment in acute phase (within72hours after onset) the patientswith intracranial aneurysms in60cases.There were26males and34females,male: female=1:1.31, age arranging from39-64years of age, with an averageage of48.00±6.30years old.60cases of intracranial aneurysm patients, theformer transport30cases, internal carotid artery12cases, middle cerebralartery16cases, others4cases; Modified Fisher grade: Grade116cases,Grade220cases, Grade315cases, Grade49cases; Hunt-Hess grade:GradeⅠ14cases, Grade II23cases, Grade III19cases, Grade IV3cases,GradeⅤ1cases. Used German production DWL Transcranial Doppler detectordetect patients before surgery, after surgery on the1st,3-5,7-10,12-14, atdifferent times the MCA, ICA1, ACA1, PCA and eICA mean velocity, andfurther to calculate the LI=(MCA/eICA), use clinical analysis of statisticalmethods, Compare the TCD detection data of the patients with SAH level(Modified Fisher grade), the onset of the state of consciousness (Hunt–Hessgrade), average days of hospitalization and prognosis.Results：1. The patients with intracranial blood flow velocity and the LIwas significantly increased from the first postoperative day, after7-10daysreached a peak, and12-14days after the operation began to decline, but this time still higher than normal levels.2. The degree of CVS is related to the amount of bleeding in subarachnoid(Modified Fisher classification), there were significant differences betweenthe small amount group and the large amount group in the degree of CVS (P<0.05).3. The degree of SAH and the preoperative neurological function status(Hunt-Hess grade) has a clear correlation, classification of the good groupand the classification of non-performing group compared to CVS extent therewas significant difference (P <0.05).4. The period after surgery on the1st day compared with the preoperative,the CVS incidence of the SAH patients have a significant difference (P<0.05).5.CVS degree of average length of stay of patients have a certaininfluence, the low velocity group compared with the high velocity group, theaverage length of stay have statistically significant (P <0.05)6. Chi-square test to different spasticity in patients with good prognosisrate: mild spasm group and non-spasm group, the difference have nosignificant difference (P>0.05); moderate spasm group and non-spasmgroup, the difference have no statistically significant (P>0.05); severespasm group and non-spasm group, the difference was statistically significant(P <0.05); moderate spasm group with mild spasm group, the difference haveno statistically significant (P>0.05); severe spasm group with mild spasticgroup, the difference was statistically significant (P <0.05); severe spasmgroup with moderate spasm groups, the difference was statistically significant(P <0.05); LI>3group and the LI≤3, the difference was statisticallysignificant (P <0.05).Conclusions：1. AS a new, non-invasive means of monitoring, TCDcould dynamic changes of the real-time monitoring of intracranial blood flow in patients at the bedside, to infer severity and clinical outcomes of CVS afterSAH, and guide the clinical treatment of patients with TCD data.2. The degree of CVS is related to the amount of bleeding in subarachnoid(Modified Fisher grade), the greater the amount of bleeding, the CVS moresevere.3. The degree of SAH and the preoperative neurological function status(Hunt-Hess grade) has a clear correlation, the worse the preoperativeneurological status, the CVS more severe.4. The period after surgery on the1st day compared with the preoperative,CVS incidence and intracranial mean blood flow velocity of SAH patients weresignificantly increased, but this difference was whether the surgery to promotethe CVS development or disease development due to be studied further.5. CVS is most obvious impact of the patient’s average length of stay, theCVS heavier with an average hospital stay was significantly prolonged.6. The prognosis of sever spasn group and severe spasm group is worsethan the mild spasm group and moderate spasm group, the prognosis of LI>3group is worse than LI≤3group.