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目的探讨重型颅脑创伤患者伤后急性期脑血流变化规律。方法利用激光多普勒脑血流仪(LDF)监测36例重型颅脑创伤患者急性期的局部脑血流(rCBF)及颅内压(ICP),通过观察rCBF的变化趋势及LDF值与脑灌注压(CPP)的相关系数r,分析rCBF的变化及脑血流自动调节功能。结果在监测第一阶段(0-12h)16例(44%)为低灌注;在第二阶段(12-24h)9例(25%)为低灌注;在第三阶段(24h以后)6例(17%)为低灌注。随着时间的推移,局部脑血流灌注量呈逐渐上升趋势。将CPP与LDF值的相关系数r作为评价脑血流自动调节功能的指数,15例(42%)至少出现一次自动调节功能受损,其中GCS 3～5分11例,GCS 6～8分4例。结论重型颅脑创伤患者在伤后急性期多发生低灌注,随着时间的推移,局部脑血流量逐渐上升。患者伤后多发生暂时性的脑血管调节功能受损,特重型颅脑创伤自动调节功能受损的发生率要高于重型颅脑创伤。
Objective To investigate the changes of cerebral blood flow during acute traumatic brain injury in patients with severe traumatic brain injury. Methods The regional cerebral blood flow (rCBF) and intracranial pressure (ICP) in 36 patients with severe craniocerebral trauma were monitored by laser Doppler flowmetry (LDF). The changes of rCBF and the relation between LDF and brain Perfusion pressure (CPP) correlation coefficient r, analysis of rCBF changes and cerebral blood flow auto-regulation function. Results In the first stage (0-12h), 16 cases (44%) had hypoperfusion; in the second stage (12-24 hours) 9 cases (25%) had hypoperfusion; in the third stage (17%) for hypoperfusion. As time went by, local cerebral blood flow perfusion increased gradually. Correlation coefficient r between CPP and LDF was used as an index to evaluate the cerebral blood flow auto-regulation function. At least one of 15 patients (42%) had an impaired autonomic dysfunction, among which GCS was 3 ~ 5 in 11 patients and GCS 6 ~ 8 in 4 example. Conclusions Patients with severe traumatic brain injury often have hypoperfusion at the acute stage of injury. As time goes by, local cerebral blood flow gradually increases. Occurred in patients with transient transient cerebrovascular regulation of impaired, severe traumatic brain injury automatic adjustment function impaired incidence is higher than that of severe traumatic brain injury.