neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"neurosurgery-27Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTИнформативность показателей состояния церебральной гемодинамики при оценке системы ликворообращения у больных с гидроцефалиейInformation capacity of cerebral hemodynamic system signs in estimating of liquor flow system at patients with hydrocephalusСеменютинВладимир БорисовичSemeniutinV. B.lbcp@mail.ruАлиевВугар АлиевичAlievV. A.noemail@neicon.ruБерсневВалерий ПавловичBersnevV. P.noemail@neicon.ruПатцакАндреасPattzakA. .noemail@neicon.ruПанунцевГригорий КонстантиновичPanuntzevG. K.noemail@neicon.ruКозловАлександр ВладимировичKozlovA. V.noemail@neicon.ruРамазановШахоб ШукуровичRamazanovSh. Sh.noemail@neicon.ruФГБУ РНХИ им. проф. А.Л. ПоленоваRussian FederationИнститут физиологии И. Мюллера Берлинского Университета им. ГумбольдтовRussian Federation201305102017026471Copyright © Семенютин В.Б., Алиев В.А., Берснев В.П., Патцак А..., Панунцев Г.К., Козлов А.В., Рамазанов Ш.Ш., 20172017Семенютин В.Б., Алиев В.А., Берснев В.П., Патцак А., Панунцев Г.К., Козлов А.В., Рамазанов Ш.Ш.Semeniutin V.B., Aliev V.A., Bersnev V.P., Pattzak A..., Panuntzev G.K., Kozlov A.V., Ramazanov S.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/27

Цель исследования: изучение информативности показателей состояния церебральной гемодинамики и её регуляции при оценке системы ликворообращения у больных с гидроцефалией. Материалы и методы. У 26 больных с гидроцефалией проводили рутинную диагностику состояния церебральной гемодинамики с помощью ТКДГ, а также оценку состояния АРМК в периоперационном периоде с помощью манжетного теста и кросс-спектрального анализа спонтанных колебаний линейной скорости кровотока (ЛСК) и системного артериального давления в диапазоне системных волн Майера. Результаты. В зависимости от наличия признаков ВЧГ, все больные были разделены на две группы. Межгрупповых достоверных различий ПИ и ЛСК не выявлено. Вместе с тем, скорость АРМК у больных с признаками ВЧГ была достоверно ниже, чем у больных без признаков ВЧГ. У больных с признаками ВЧГ в послеоперационном периоде клиническое улучшение сопровождалось достоверным (p<0,05) повышением скорости АРМК. Во второй группе оперированных больных без признаков ВЧГ существенного улучшения в неврологическом статусе и изменения скорости АРМК в послеоперационном периоде выявлено не было. Заключение. Данные оценки АРМК, являясь более информативными, чем ПИ, могут быть использованы для более тщательного отбора пациентов с гидроцефалией для проведения оперативного вмешательства.

Background. It was shown an opportunity of non-invasive diagnostics of intracranial hypertension (ICH) on the base of pulsatility index (PI) using transcranial Doppler (TCD) in most neurosurgical patients. But in patients with hydrocephalus PI is controversial. This may be due to different degree of cerebral autoregulation (CA) impairment in case of cerebral perfusion pressure decrease. Purpose: to assess the informativity of cerebral hemodynamics indices for assessment of cerebrospinal fluid circulation in patients with hydrocephalus. Materials and methods. Routine diagnostics of cerebral blood flow velocity (BFV) by means of TCD was carried out in 26 patients with hydrocephalus. Cerebral autoregulation was assessed perioperatively with cuff test and cross-spectral analysis of spontaneous oscillations of blood pressure and BVF within the range of Meyer waves. Results. Depending on presence of intracranial hypertension (ICH), all patients have been divided in two groups: with signs of ICH (1st group) and without ICH (2nd group). Mean values of PI didn’t differ significantly in both groups. At the same time rate of CA were considerably (p<0.01) higher in patients without signs of ICH. In the 1st group postoperative clinical improvement was accompanied with considerable (p<0.05) increase of rate of CA. In the 2nd group of operated patients we didn’t observe any positive changes in neurological state postoperatively. After surgery CA hasn’t been changed significantly. Conclusion. Assessment of cerebral autoregulation being more informative than PI evaluation can increase TCD valuability in noninvasive diagnostics of cerebrospinal liquid dynamics and could be used for clarifying indications for operation in patients with hydrocephalus.

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The authors declare that there are no conflicts of interest present.