Abstract: Objective To investigate the brain blood stream changes that recorded by transcranial Doppler(TCD) during acute stage of the spontaneous intracerebral hemorrhage and its relationship with30-day death.Methods We prospectively included 87 patients with first-ever supratentorial, nontraumatic ICH.CT and TCD examination were performed in the acute stage (less than 24 hours from symptomonset). All 48 patients completed 4 times TCD examinations on the 1st, 3rd, 7th, 14th day afteronset. TCD recordings were obtained from the middle cerebral arteries, following variables wereanalyzed: systolic(Vs), diastolic (Vd), mean (Vm)velocities, pulsatiliy index and resistive indexfrom the affected and unaffected hemispheres.Results TCD variables of small-volume group within 24 hours from symptom onset were normal.Vm in unaffected hemisphere (P <0.01) and Vd in both hemispheres (affected hemisphere: P <0.01;unaffected hemisphere: P <0.01)in large-volume group were lower than those in mid-volume andsmall-volume groups. PI (affected hemisphere: P =0.001; unaffected hemisphere: P =0.001)andRI (affected hemisphere: P =0.001; unaffected hemisphere: P <0.01) in both hemispheres in largevolumegroup were higher than those in mid-volume and small-volume groups. Vm in bothhemispheres decreased gradually within 14 days after onset. Vd in unaffected hemisphere in deadgroup were lower than that in survival group (P <0.01).PI and RI in both hemispheres in dead groupwere higher than that in survival group (P <0.01).Conclusion Aemodynamic parameters of TCD may show the brain blood stream changes of ICHpatients and highly predict death in 30 days after onset.

Key words: Cerebral hemorrhage; Ultrasonography; Doppler; transcranial; Outcomeasseasmen

摘要： 目的 探讨原发性脑出血（spontaneous intracerebral hemorrhage，ICH）急性期经颅多普勒（transcranialdoppler，TCD）超声血流参数变化规律及与30d死亡的相关性。方法 前瞻性入组87例首次发病24h以内，原发幕上脑出血患者。按照出血量分为小量出血组（n=21）、中量出血组（n=27）和大量出血组（n=39）。入组患者发病24h内行颅脑计算机断层扫描（computed tomography，CT）检查。于发病24h内、第3、7、14d行床旁TCD监测，记录双侧大脑中动脉收缩期峰值血流速度（systolic velocities，Vs）、舒张期血流速度（diastolic velocities，Vd）、平均血流速度（mean velocities，Vm）、搏动指数（pulsatility index，PI）、阻力指数（resistive index，RI）。其中48例患者完成全部TCD监测。对各组血流动力学参数进行比较。结果 发病24h以内，小量出血组血流动力学参数接近正常值；中量、大量出血组健侧Vm降低（P <0.01），双侧Vd降低（患侧：P＜0.01；健侧P＜0.01），双侧PI、R（I 患侧：P =0.001；健侧：P＜0.01）升高，大量出血组较中量出血组变化明显。脑出血发病14d以内双侧Vm值呈持续下降趋势。30d死亡患者健侧Vd比存活患者显著降低（P <0.01），双侧PI，RI升高（P＜0.01）。结论 TCD血流参数的变化可以反映脑出血急性期颅内血流变化规律，是评估预后的重要指标。

关键词: 脑出血; 超声检查; 多普勒; 经颅; 结局