蛛网膜下腔出血急性期经颅多谱勒及血浆心钠素对照探究.docVIP

蛛网膜下腔出血急性期经颅多谱勒及血浆心钠素对照探究【摘要】 目的 为探讨蛛网腔下腔出血（SAH）患者急性期TCD变化与血浆心纳素（ANF）之间的关系。方法 选择41例SAH患者及22例正常对照组，进行TCD及血浆ANF检测。结果 41例SAH患者大脑中动脉（MCA）血流速度及血浆ANF明显高于对照组。且SAH患者血浆ANF水平随MCA血流速度变化而变化。结论 SAH患者MCA血流速度与血浆ANF之间存在一定联系。血浆ANF可作为评价SAH出血后脑血管痉挛（CVS）发生程度的参考指标。对指导治疗及判断预后有一定价值。 【关键词】 蛛网腔下腔出血；心纳素；TCD Contrast study between TCD and atrial natriuretic popypeptid in acute subarachnoid hemorrhage ZHOU Wu, Department of Neurology, The 5th affiliated Hospital,Sun Yat-sen University, Zhuhai,519000,China 【Abstract】 Objective To investigate the regulation between cerebrovascular spasm (CVS) and plasma atrial natriuretic factor (ANF) after subarachnoid hemorrhage (SAH). MethodsMeasured the level of plasma ANF by radioimmunoassay and the middle cerebral artery blood flew velocity (MCAV) by TCD in 42 cases of acute SAH and normal cases. Results The MCAV and the level of plasma ANF are significantly increased in SAH with that of normal cases.The level of plasma ANF varies with the MCAV, the more MCAV faster, the more higher levels of plasma ANF. Conclusion There is certain relationship between the MCAV and the levels of plasma ANF in SAH,the levels of plasma ANF can help to evalute the degrees about the CVS in SAH, it is of value for predicting outcome and guiding treatment of patient with SAH. 【Key words】 Subarachnoid hemorrhage；Atrial natriuretic popypeptide；TCD 蛛网膜下腔出血（Subarachnoid hemorrhage，SAH）是一种常见脑血管疾病，其严重威胁人类生命和健康。脑血管痉挛（cerebrovascular spasm，CVS）是SAH后最常见并发症。有学者[1，2] 应用经颅多谱勒（transcranial Doppler，TCD）对SAH后CVS进行分析和研究，认为脑血流速度可作为CVS的早期诊断手段；心纳素又称心房利钠因子（atrial natriurefic factor，ANF），目前认为它参与了SAH患者中枢神经系统（CNS）病损后病理生理变化，也见相关报道[3，4]。但把TCD技术与血浆ANF结合起来对SAH患者进行对比研究，尚未见报道，本研究采用放射免疫测定法结合TCD对42例SAH患者进行了对照研究，报告如下： 1 资料和方法 1．1 资料 41例SAH急性期患者，男28例、女13例、年龄27～71岁（平均 46±13岁），按1986年中华医学会全国脑血管病学术会议修订的各类脑血管病诊断标准确诊，经头颅CT扫描证实，对照组22例，男12例，女10例，均选自同期本院住院的腰椎间盘突出患者，两组均排除心、肾疾病，高血压及内分泌疾病。 1．2 方法 1．2．1 SAH组于发病后第5天清晨卧位采肘静脉血3 ml，置于含30 ul 10%EDTA和50 ul抑肽酶塑料离心管中混匀，离心（40C 3000 r/min,15 min）,取上清液-40℃保存