Clincal Application Value Research Of Non-invasive Intracranial Pressure Monitoring With Tcd In Patients With Serious Traumaticbrain Injury

Objective:To monitor the intracranial pressure (ICP) and examie the characteres of Transcranial Doppler ultrasonography (TCD) in patients with serious traumaticbrain injury (TBI), in order to further evaluate the clinical application value of non-invasive ICP monitoring with TCD.Method:The microsensors of intracranial pressure monitor were inserted into cerebral parenchyma adjacent to operative sites and connected to intracranial pressure monitor apparatus for continuous bed-beside ICP monitoring in48patients with TBI. The monitoring and measurements with TCD were performed beside beds on the following day of surgery to record the spectral atlas systolic peak velocity (Vs), end of diastolic velocity (Vd)、mean velocity (Vm)-pulsatility index (PI) and resistance index (RI) of the middle cerebral artery (MCA) of suffering side. The values of ICP were recorded at the same time. The patients were divided into Normal ICP Group (ICP<15mmHg, n=13), Mild ICP Increase Group (15mmHg<ICP<20mmHg, n=12), Moderate ICP Increase Group (20mmHg≤ICP<40mmHg, n=12)and Severe ICP Increase Group (ICP>40mmHg, n=11).The comparative analyses of results of TCD and ICP monitoring were carried out.Results:1. Outcome:A total of25patients in the Normal ICP Group and Mild ICP Increase Group:19cases were cured and6case of moderate disability;12patients in Moderate ICP Increase Group, of which2cases died of ICP rising caused by postoperative brain edema,1patients transfer to another hospital after better,1cases of severe disability,3cases of moderate disability, and another5cases cured discharge;11patients in Severe ICP Increase Group, of which6cases died,1patients requested to discharge from hospital,3cases of severe disability,1case of moderate disability.2. Spectral atlas:The spectral atlas of Mild ICP Increase Group showed no visible differences from those of Normal ICP Group. A phenomenon of deepened notch before reaching D peak was found in some cases of Moderate ICP Increase Group while occurrence of single cusp peak and disappearance of S2peak with decreased diastolic velocity were observed in Severe ICP Increase Group.3. Parameter of TCD:With the increase of ICP, Vs, Vd and Vm were decreased accordingly with the most significant dropping in Vd while PI and RI were elevated gradually. Statistical analyses showed that there were no significant differences in Vs between each increased ICP group and Normal ICP Group(p>0.05). All the parameters from Mild ICP Increase Group had no statistical differences from those of Normal ICP Group (p>0.05). Vd, Vm, PI and RI from either Moderate ICP Increase Group or Severe ICP Increase Group demonstrated statistical changes compared to relative parameters of Normal ICP Group(p<0.05).Conclusion:This study suggested that TCD could be applied to monitor noninvasively ICP and indicate the significant increase of ICP in patients with TBI, but fail to detect mild increase of ICP. Spectral atlas is superior to parameters of TCD in judgment of increased ICP.