姬中庆 王瑾

[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、預后效果。 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。

[关键词] 经颅多普勒超声；微血管多勒普超声；出血性动脉瘤

[中图分类号] R743 [文献标识码] A [文章编号] 1673-7210（2018）08（b）-0100-04

[Abstract] 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.

[Key words] Transcranial Doppler ultrasound； Microvascular Doppler ultrasound； Hemorrhagic aneurysm

出血性动脉瘤为临床常见脑血管疾病类型，致残率可达80%，并且其经手术治疗后病死率仍高达14%左右，对患者生命健康造成了巨大威胁[1-3]。因此，出血性动脉瘤发病后应及时实施准确诊断并采取手术等措施进行干预，并于术中进行有效监测，以便能及时发现需进行特别处理的问题，以此降低疾病致残及病死风险，改善疾病治疗效果及预后效果。但国内外相关研究认为，围术期受诸多条件限制，难以应用大型设备仪器，且大型设备仪器仅可一次性提供影像方面资料，难以准确辨别术中血流动力学变化情况，在一定程度上增加了出血性动脉瘤治疗风险[4-6]。……