脑电图与经颅多普勒评估和预测蛛网膜下腔出血并发症

余　敏; 詹　青; 赵江民

doi:10.12022/jnnr.2017-0025

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神经病学与神经康复学杂志 ›› 2017, Vol. 13 ›› Issue (3) : 132-137. DOI: 10.12022/jnnr.2017-0025

综述

脑电图与经颅多普勒评估和预测蛛网膜下腔出血并发症

余　敏1，詹　青1，赵江民2

作者信息 +

Electroencephalogram and transcranial Doppler in evaluation and prediction of complications related to subarachnoid hemorrhage

YU Min1, ZHAN Qing1, ZHAO Jiangmin2

Author information +

文章历史 +

摘要

蛛网膜下腔出血（subarachnoid hemorrhage，SAH）的严重并发症包括脑血管痉挛（cerebral vasospasm，CVS）、脑积水和症状性癫痫，严重影响着患者的预后。在这些并发症的发生初期，大脑功能或结构大多已存在早期或不典型的变化。本研究阐述了脑电图（electroencephalogram，EEG）和经颅多普勒（transcranial Doppler，TCD）等相关技术在评估和预测SAH并发症中的应用价值，指出EEG和TCD有助于临床上及时开展有效的评估和干预，从而阻止SAH后持续的脑损害，改善SAH患者的预后。

Abstract

The severe complications of subarachnoid hemorrhage (SAH) include cerebral vasospasm (CVS), hydrocephalus and symptomatic epilepsy, which seriously affect the prognosis of patients. In the early stage of these complications, most of the brain’s functions or structure has undergone early or atypical changes. This study describes the applications of electroencephalogram (EEG) and transcranial Doppler (TCD) in evaluation and prediction of SAH complications. It is pointed out that EEG and TCD may contribute to the clinical evaluation and intervention in a timely and effective manner, thus prevent the brain damage after SAH and improve the prognosis of patients with SAH.

导出引用

余　敏，詹　青，赵江民. 脑电图与经颅多普勒评估和预测蛛网膜下腔出血并发症[J]. 神经病学与神经康复学杂志. 2017, 13(3): 132-137 https://doi.org/10.12022/jnnr.2017-0025

YU Min, ZHAN Qing, ZHAO Jiangmin. Electroencephalogram and transcranial Doppler in evaluation and prediction of complications related to subarachnoid hemorrhage[J]. Journal of Neurology and Neurorehabilitation. 2017, 13(3): 132-137 https://doi.org/10.12022/jnnr.2017-0025

参考文献

[1] Sehba FA, Hou J, Pluta RM, et al. The importance of early brain injury after subarachnoid hemorrhage[J]. Prog Neurobiol, 2012, 97(1):14-37.
[2] Fujii M, Yan J, Rolland WB, et al. Early brain injury, an evolving frontier in subarachnoid hemorrhage research[J]. Transl Stroke Res, 2013, 4(4):432-446.
[3] 中华医学会神经外科学分会. 脑血管痉挛防治神经外科专家共识[J]. 中国卒中杂志, 2008, 3(5):356-362．
[4] Francoeur CL, Mayer SA. Management of delayed cerebral ischemia after subarachnoid hemorrhage[J]. Crit Care, 2016, 20(1):277.
[5] Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: A guideline for healthcare professionals from the American Heart Association/american Stroke Association[J]. Stroke, 2012, 43(6):1711-1737.
[6] Steiner T, Juvela S, Unterberg A, et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage[J]. Cerebrovasc Dis, 2013, 35(2):93-112.
[7] Marshall SA, Nyquist P, Ziai WC. The role of transcranial Doppler ultrasonography in the diagnosis and management of vasospasm after aneurysmal subarachnoid hemorrhage[J]. Neurosurg Clin N Am, 2010, 21(2):291-303.
[8] Carrera E, Schmidt JM, Oddo M, et al. Transcranial Doppler ultrasound in the acute phase of aneurysmal subarachnoid hemorrhage[J]. Cerebrovasc Dis, 2009, 27(6):579-584.
[9] 华　扬. 实用颈动脉与颅脑血管超声诊断学[M]. 北京: 科学出版社, 2002:101.
[10] Soustiel JF, Shik V. Posttraumatic basilar artery vasospasm[J]. Surg Neurol, 2004, 62(3):201-206.
[11] 唐　博, 李东原, 赵丛海. TCD诊断蛛网膜下腔出血后脑血管痉挛的研究进展[J]. 中国实验诊断学, 2012, 16(10):1942-1945.
[12] Kohama M, Sugiyama S, Sato K, et al. Difference in transcranial Doppler velocity and patient age between proximal and distal middle cerebral artery vasospasms after aneurysmal subarachnoid hemorrhage[J]. Cerebrovasc Dis Extra, 2016, 6(2):32-39.
[13] Djelilovic-Vranic J, Basic-Kes V, Tiric-Campara M, et al. Follow-up of vasospasm by transcranial Doppler sonography (TCD) in subarachnoid hemorrhage (SAH)[J]. Acta Inform Med, 2017, 25(1):14-18.
[14] Gonzalez NR, Boscardin WJ, Glenn T, et al. Vasospasm probability index: a combination of transcranial doppler velocities, cerebral blood flow, and clinical risk factors to predict cerebral vasospasm after aneurysmal subarachnoid hemorrhage[J]. J Neurosurg, 2007, 107(6):1101-1112.
[15] Oertel MF, Scharbrodt W, Wachter D, et al. Arteriovenous differences of oxygen and transcranial Doppler sonography in the management of aneurysmatic subarachnoid hemorrhage[J]. J Clin Neurosci, 2008, 15(6):630-636.
[16] Neulen A, Prokesch E, Stein M, et al. Image-guided transcranial Doppler sonography for monitoring of vasospasm after subarachnoid hemorrhage[J]. Clin Neurol Neurosurg, 2016, 145:14-18.
[17] Gollwitzer S, Groemer T, Rampp S, et al. Early prediction of delayed cerebral ischemia in subarachnoid hemorrhage based on quantitative EEG: A prospective study in adults[J]. Clin Neurophysiol, 2015, 126(8):1514-1523.
[18] Claassen J, Hirsch LJ, Kreiter KT, et al. Quantitative continuous EEG for detecting delayed cerebral ischemia in patients with poor-grade subarachnoid hemorrhage[J]. Clin Neurophysiol, 2004, 115(12):2699-2710.
[19] Rots ML, van Putten MJ, Hoedemaekers CW, et al. Continuous EEG monitoring for early detection of delayed cerebral ischemia in subarachnoid hemorrhage: a pilot study[J]. Neurocrit Care, 2016, 24(2):207-216.
[20] Stuart RM, Waziri A, Weintraub D, et al. Intracortical EEG for the detection of vasospasm in patients with poor-grade subarachnoid hemorrhage[J]. Neurocrit Care, 2010, 13(3):355-358.
[21] Vale FL, Bradley EL, Fisher WS 3rd. The relationship of subarachnoid hemorrhage and the need for prostoperative shunting[J]. J Neurosurg, 1997, 86(3):462-466.
[22] Komotar RJ, Hahn DK, Kim GH, et al. The impact of microsurgical fenestration of the lamina terminalis on shunt-dependent hydrocephalus and vasospasm after aneurysmal subarachnoid hemorrhage[J]. Neurosurgery, 2008, 62(1):123-132.
[23] Little AS, Zabramski JM, Peterson M, et al. Ventriculoperitoneal shunting after aneurysmal subarachnoid hemorrhage: analysis of the indications, complications, and outcome with a focus on patients with borderline ventriculomegaly[J]. Neurosurgery, 2008, 62(3):618-627.
[24] Rainov NG, Weise JB, Burkert W. Transcranial Doppler sonography in adult hydrocephalic patients[J]. Neurosurg Rev, 2000, 23(1):34-38.
[25] Krauss JK, Droste DW. Predictability of intracranial pressure oscillations in patients with suspected normal pressure hydrocephalus by transcranial Doppler ultrasound[J]. Neurol Res, 1994, 16(5):398-402.
[26] Rosenthal RJ, Hiatt JR, Phillips EH, et al. Intracranial pressure. Effects of pneumoperitoneum in a large-animal model[J]. Surg Endosc, 1997, 11(4):376-380.
[27] 万　衡, 于文生, 周泽永, 等. 经颅多普勒在脑积水中的应用价值. 中国临床神经外科杂志, 2006, 11(11):678-679.
[28] 曾　剑, 肖小培, 周咏梅. 经颅多普勒在脑积水中的价值[J]. 四川医学, 2012, 33(1):41-44.
[29] Braun KP, van Eijsden P, Vandertop WP, et al. Cerebral metabolism in experimental hydrocephalus: an in vivo 1H and 31P magnetic resonance spectroscopy study[J]. J Neurosurg, 1999, 91(4):660-668.
[30] Kondziella D, Lüdemann W, Brinker T, et al. Alterations in brain metabolism, CNS morphology and CSF dynamics in adult rats with kaolin-induced hydrocephalus[J]. Brain Res, 2002, 927(1):35-41.
[31] Graebner RW, Gastone GC. EEG finding in hydrocephalus and their relation to shunting procedures[J]. Electroencephalogr Clin Neurophysiol, 1973, 35(5):517-521.
[32] 肖　华, 李小晶, 李智华, 等. 370例婴儿外部性脑积水就诊原因与脑神经电生理学改变分析[J]. 中国妇幼保健, 2004, 19(8):95-96.
[33] 郭　宁. 婴儿外部性脑积水与围产期窒息18例临床分析[J]. 重庆医学, 1999, 28(4):261-262.
[34] Uzzo RG, Bilsky M, Mininberg DT, et al. Laparoscopic surgery in children with ventriculoperitoneal shunts: effect of pneumoperitoneum on intracranial pressure--preliminary experience[J]. Urology, 1997, 49(5):753-757.
[35] 杨志国, 王贤书, 岳　芳, 等. 小儿脑积水脑室腹腔分流术前后脑电图及电脑地形图对比分析[J]．山东医药杂志, 2007, 47(32):98-99.
[36] Lin YJ, Chang WN, Chang HW, et al. Risk factors and outcome of seizures after spontaneous aneurysmal subarachnoid hemorrhage[J]. Eur J Neurol, 2008, 15(5):451-457.
[37] Choi KS, Chun HJ, Yi HJ, et al. Seizures and epilepsy following aneurysmal subarachnoid hemorrhage: incidence and risk factors[J]. J Korean Neurosurg Soc, 2009, 46(2):93-98.
[38] Human T, Diringer MN, Allen M, et al. A randomized trial of brief versus extended seizure prophylaxis after aneurysmal subarachnoid hemorrhage[J/OL]. Neurocrit Care, 2017 (2017-08-22)[2017-09-25]. DOI: 10.1007/s12028-017-0440-5.
[39] Lin CL, Dumont AS, Lieu AS, et al. Characterization of perioperative seizures and epilepsy following aneurysmal subarachnoid hemorrhage[J]. J Neurosurg, 2003, 99(6):978-985.
[40] 桂　华. 蛛网膜下腔出血的脑电图分析[J]. 实用医技杂志, 2007, 14(1):57-58.
[41] Claassen J, Mayer SA, Kowalski RG, et al. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients[J]. Neurology, 2004, 62(10):1743-1748.
[42] De Marchis GM, Pugin D, Meyers E, et al. Seizure burden in subarachnoid hemorrhage associated with functional and cognitive outcome[J]. Neurology, 2016, 86(3):253-260.