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目的:利用经颅多普勒(TCD)技术监测颅缝早闭症患儿手术前后脑血流动力学变化,评价颅缝早闭症手术的减压效果。方法:11例患儿按年龄分3个年龄组:0～3岁组4例;4～7岁组5例;11岁组2例。TCD以双侧大脑中动脉为靶血管,记录患儿手术前后的脑血流速度[收缩峰速度(Vs)和舒张期速度(Vd)]和搏动指数(PI),同时记录血压和脉搏数。结果:0～3岁组,手术后Vs、Vd明显提高(P<0.05),PI明显降低(P>0.05),4例患儿头颅X线平片均见指压纹;4～7岁组,手术后Vs、Vd提高,PI降低(P<0.05);11岁组,手术后Vs、Vd、PI改变不明显(P>0.05)。结论:手术对于改善较小患儿脑血流速度和PI的作用显著;对于稍大患儿舒张期脑血流的改善较收缩期血流明显、PI明显降低。提示手术减压效果明显,TCD可作为非损伤性评价颅狭症手术效果的简便工具。
Objective: To observe the changes of cerebral hemodynamics before and after operation in children with craniosynostosis by transcranial Doppler (TCD) technique and to evaluate the decompression effect of cranial suture and premature closure surgery. Methods: Eleven patients were divided into three age groups by age: 4 in 0-3 years old group, 5 cases in 4-7 years old group and 2 cases in 11 years old group. TCD was used as target vessel in bilateral middle cerebral artery. The cerebral blood flow velocity (peak systolic velocity (Vs) and diastolic velocity (Vd)] and pulsatility index (PI) before and after surgery were recorded. Blood pressure and pulse rate were also recorded. Results: The Vs, Vd were significantly increased (P <0.05) and PI were significantly decreased in the 0-3 years old group (P> 0.05) Vs, Vd and PI decreased after operation (P <0.05). There was no significant change of Vs, Vd and PI after operation in 11-year-old group (P> 0.05). CONCLUSIONS: Surgery has a significant effect on improving cerebral blood flow velocity and PI in younger children. The improvement in diastolic cerebral blood flow in slightly larger children is more pronounced than in systolic blood flow, and PI is significantly lower. TCD decompression effect is obvious, TCD can be used as a non-invasive evaluation of the effectiveness of cranial stenosis surgery a simple tool.