经颅多普勒对儿童烟雾病脑-硬脑膜-动脉血管融通术的疗效评价_烟雾病手术需要卉颅吗

　　[摘要] 目的 观察烟雾病患儿行脑-硬脑膜-动脉血管融通术（EDAS）后大脑中动脉主干（MCA）及颞浅动脉（STA）的经颅多普勒多普勒（TCD）频谱参数变化特点，并通过与临床疗效的比较，探讨TCD频谱参数与临床预后的相关性。方法 65例行EDAS手术治疗的烟雾病患儿在实施EDAS手术前及术后半年分别行TCD检测，对患者手术前后STA、MCA主干平均流速（Vm）、搏动指数（PI）及阻力指数（RI）进行对比分析，探索STA Vm、PI变化特点，分析手术前后脑血流状况变化特点及与临床预后的关系。 结果 术后STA的Vm较术前明显增快，PI较术前明显降低。临床预后良好组与不良组比较，可发现STA的Vm、PI有差别。通过Spearman秩相关分析，发现STA手术前后的Vm比值、术后PI值都与临床预后状况显著相关（r = -0.461和r = 0.534）。通过ROC曲线，发现联合Vm、PI进行诊断界限值计算，特异度与敏感度分别为83.4%和80.0%，阳性预测值与阴性预测值分别为93.0%和60.0%，阳性似然比为4.0。 结论 TCD能检测烟雾病患儿EDAS术后MCA、STA的频谱变化，可作为无创性评价EDAS手术疗效的有效方法。
　　[关键词] 经颅多普勒；烟雾病；脑血流；脑血管重建术
　　[中图分类号] R725 [文献标识码] B [文章编号] 1673-7210（2012）07（a）-0095-03
　　Evaluation on the efficacy of encephaloduroarteriosynangiosis of the childhood moyamoya disease with TCD
　　LIU Bin REN Hongbo LIU Jixiang ZHANG Shan SUN Zhiqiang WU Feng
　　The First Department of Neurosurgery, Handan Central Hospital, Hebei Province, Handan 056001, China
　　[Abstract] Objective To discuss the association between STA and MCA spectrum using pulse Doppler after EDAS and clinical efficacy of the childhood moyamoya disease and find spectrum of Doppler in predicting clinical efficacy after EDAS in MMD. Methods There were 65 children with moyamoya disease. Before and 6 months after EDAS, TCD studies were performed. It was analyzed that data of Peak velocity (Vp), diastolic velocity (Vd), mean velocity (Vm), pulsatility index (PI) and resistance index (RI) of MCA and STA. The pulse Doppler parameters and clinical efficacy after EDAS were compared. Results STA Vm was significantly faster and PI was significantly decreased after surgery. It could be found significant differences in the Vm and PI of STA between good and bad clinical outcome group. By the Spearman rank correlation analysis, the ratio of Vm in the STA before and after surgery and postoperative PI values were significantly associated with the clinical prognosis (r = -0.461 and r = 0.534). By the ROC curve could find application of combined PI and Vm ratio to carry out the diagnostic threshold values calculation, the specificity and sensitivity were 83.4% and 80.0%, positive predictive value and negative predictive values were 93.0% and 60.0%, positive likelihood ratio was 4.0. Conclusion TCD can detect MCA, STA spectrum changes in child MMD patients after EDAS, and can be used as an effective method of noninvasive evaluation of EDAS surgery.
　　[Key words] Transcranial Doppler; Moyamoya disease; Cerebral blood flow; Cerebral revascularization