The Evaluation And Application Of TCD In Cerebral Edema And Intracranial Pressure Caused By Hypertensive Cerebral Hemorrhage

ObjectiveTranscranial Doppler Sonography(TCD)was used to investigate the effects of cerebral edema and intracranial pressure on hemodynamics in patients with hypertensive cerebral hemorrhage.(The dynamic changes of cerebral edema and intracranial pressure were reflected via monitoring cerebral hemodynamic parameters with TCD,which provided a basis for the timely control of cerebral edema and intracranial pressure)MethodsAccording to the inclusion criteria,a total of 80 cases were recruited.50 patients with hypertensive intracerebral hemorrhage in the experimental group were divided into three groups according to the size of cerebral hematoma(<10ml,10-20 ml,>20ml)while the 30 normal subjects whose age,sex and body mass index were matched were classified into group D as the control group.On the 1st,3rd and 7th day,group A,B,C routinely performed cranial CT scan,transcranial Doppler ultrasonography(TCD)as well as lumbar punctures measuring cerebrospinal fluid pressure,while patients in group D only had a lumbar puncture.Cerebral edema volume,cerebral hematoma volume,Doppler ultrasound parameters,and intracranial pressure(ICP)were recorded respectively.The cerebral edema volume,cerebral hematoma volume,ICP and TCD parameters of the four groups were expressed by the mean standard deviation.The results were analyzed with SPSS 22.0 statistical software by performing variance analysis,comparison between groups and comparison of nodes at different time points.Results1.The increased intracranial pressure results in the Doppler ultrasound spectrum of the cerebral hemorrhage patients with a sharp contraction peak,forming a characteristic high-resistance,low-flow waveform.When intracranial pressure was further increased,Vs,Vd and Vm decreased and PI increased.2.On the first day of the hemorrhage attacking,the hematoma volume was positively correlated with ICP,while the edema volume was not related to ICP.ICP and the hematoma volume have a positive connection to PI but a negative relation to Vd(r=0.320?r=0.421?r=-0.516?r=-0.348;P=0.006?P=0.002?P=0.000?P=0.019),and have no correlation with Vm,Vs(P>0.05).Compared with group D,Vd and Vm both decreased in groups A,B as well as C whereas PI increased,and Vs shows no change(P>0.05).and hematoma volume was only positively correlated with PI in TCD parameters.3.On the 3rd day of the hemorrhage attacking,hematoma volume was positively correlated with ICP(r=0.675?P=0.000),while the edema volume was positively correlated with ICP(r=0.777?P=0.000).Both ICP and the edema volume show a positive correlation with PI but a negative relation to Vd(r=0.530,0.321,r=-0.341,r=-0.355;P=0.000,P=0.025,P=0.002,P=0.018),and have no connection to Vm and Vs(P>0.05).The Vd,Vm as well as Vs in group A,B and C were lower than those in group D(P<0.05),whereas PI was increased(P<0.05).ICP and edema were correlated with PI and Vd in TCD parameters,but not with Vm and Vs.4.On the 7th day of the hemorrhage attacking,the hematoma volume was positively correlated with ICP(r=0.477?P=0.000),and edema volume also has a positive relation with ICP(r=0.751?P=0.000.).ICP and the edema volume were positively correlated with PI while negatively correlated with Vd,and had no correlation with Vm and Vs(r=0.673,0.479,r=-0.316,r=-0.299;P=0.000,P=0.000,P=0.002,P =0.017).The Vd,Vm as well as Vs have no change in group A,B and C compared with group D(P>0.05),as PI increased(P<0.05).ICP and edema were correlated with PI and Vd in TCD parameters,while Vm and Vs were not.5.When the hematoma volume and edema volume on the 3rd and 7th were compared to those on the 1st day,there were some changes in the edema volume but not in the hematoma volume.Compared to the TCD parameters on the 1st day,Vd,Vm,Vs and PI of group A showed no change on the 3rd and 7th day(P>0.05).Compared with the 1st day,the TCD parameters in group B showed no change in Vs as well as Vm on the third day(P>0.05),while Vd decreased(P<0.05),and PI increased(P<0.05).Comparing the TCD parameters of group C on the 3rd day with those on the 1st day,Vd,Vm as well as Vs were all decreased(P<0.05)whereas PI increased(P<0.05).Comparing the TCD parameters of group D on the 7th day with those on the 1st day,Vs and Vm displayed no change(P>0.05),while Vd and PI decreased(P<0.05).Conclusions1.The change of hemodynamic parameters of TCD can reflect the dynamic change of ICP.2.The dynamic changes and extent of the edema can be mirrored by the alteration of TCD hemodynamic parameters.