目的探讨床旁经颅多普勒超声（transcranial Doppler ultrasound, TCD）在神经重症脑血管疾病患者中的监测效果及应用。方法四川大学华西医院重症医学科（ICU）神经ICU2016年12月至2018年10月对96例脑血管疾病患者（脑动脉瘤破裂出血术后39例，未行手术者1例；高血压脑出血术后38例，未行手术者6例；其他脑血管疾病术后8例，未行手术者4例）采用床旁TCD进行监测，包括经颞窗探测双侧大脑中动脉（middle cerebral artery，MCA），经枕窗探测基底动脉（basilar artery，BA），监测其收缩期峰值血流速度、舒张末期峰值血流速度、平均峰值血流速度、血管搏动指数、血管阻力指数、血流频谱形态以此了解局部血流动力学改变。根据监测结果分为血管痉挛组、血流增快组和供血不足组。收集监测结果进行临床分析。结果脑血管疾病患者均顺利完成床旁TCD监测，监测结果显示，96例患者中脑血流增快者37例（38.54%），脑血管痉挛者15例（15.62%），脑供血不足者93例（90.62%，包括MCA、BA供血不足）。TCD监测结果在不同病因中的分布，病因中的主要类型脑动脉瘤和高血压脑出血患者供血不足发生率高，其次为血流增快，血管痉挛发生率相对较低，脑动脉瘤和高血压脑出血组间供血不足、血流增快，血管痉挛发生率差异有统计学意义（P<0.05）。结论床旁TCD监测可评估患者颅脑血流动力学信息，为临床治疗提供一定的指导依据。“,”ObjectiveTo investigate the monitoring effect and application of transcranial Doppler ultrasound (TCD) in patients with severe neurovascular cerebrovascular diseases.MethodsFrom December 2016 to October 2018, 96 patients with cerebrovascular disease in Department of Neurology and ICU, West China Hospital, Sichuan University were monitored by bedside TCD, including the detection of bilateral middle cerebral arteries (MCAs) through temporal window, and the detection of the basilar artery (BA) through occipital window, characterized by the peak systolic blood flow velocity, peak diastolic blood flow velocity, average peak blood flow velocity, vascular pulsatility index, vascular pulsatility index, vascular resistance index and blood flow spectrum morphology in local hemodynamic changes. According to the monitoring results, it was divided into vasospasm group, increased blood flow group and insufficient blood supply group. Relevant data of monitoring results were analysed.ResultsBedside TCD monitoring was successfully used to all cerebrovascular diseases patients. Among 96 patients, 37 patients (38.54%) had increased cerebral blood flow, 15 patients (15.62%) had cerebral vasospasm, and 93 patients had insufficient cerebral blood supply (90.62%, including insufficient blood supply to the MCA and BA). Patients mainly with cerebral aneurysm and hypertensive intracerebral hemorrhage types contributed the highest proportion of insufficient blood supply, followed by the increase of blood flow, and the incidence of vasospasm was relatively low. In cerebral aneurysm group and hypertensive intracerebral hemorrhage group, and differences in the incidence of insufficient blood supply, increased blood flow, and vasospasm were statistically significant (P<0.05).ConclusionThe bedside TCD monitoring can assess the patient's craniocerebral hemodynamic information and provide a clinical guidance.