应用TCD探讨高血压病患者脑血管病变特点的研究

目的应用经颅多普勒超声（TCD）探讨高血压病各期患者脑血管损伤的程度，为闭塞性脑血管疾病的防治提供依据。方法收集高血压病患者176例，采用TCD探查颅内动脉的收缩期血流速度（Vs）、舒张期血流速度（Vd）、平均血流速度（Vm）、搏动指数（PI）等血流动力学参数，并进行统计学分析。结果高血压Ⅰ期组颅内动脉血流速度普遍升高，以大脑中动脉、颈内动脉终末端血流速度增快明显；高血压Ⅱ期组、Ⅲ期组随着血压的逐渐升高，颅内动脉的血流速度逐渐减缓，以大脑中动脉、颈内动脉终末端及基底动脉血流速度减缓显著。高血压各组TCD检测总异常率77％，Ⅱ、Ⅲ期高血压病组的异常率分别为90％和96％。结论TCD检测的脑血管血流动力学特点与卒中特点吻合，可作为高血压病所致闭塞性脑血管疾病早期发现和早期防治的有效手段。     

脑鸣患者的经颅多普勒超声表现

目的利用经颅多普勒超声(TCD)检测脑鸣患者的脑血流情况,并对相关情况进行分析、总结。方法用TCD仪对153例脑鸣患者颅内主要动脉进行检测。结果 153例脑鸣患者中,122例检测出有血流动力学改变,占79.7%,其中血流速度增快70例(57.4%),血流速度减慢45例(36.9%),血流速度增快患者明显高于血流速度减慢者(χ2=8.966,P=0.003),狭窄7例(5.7%)。前循环血流动力学改变35例(28.7%),后循环45例(36.9%),前后循环均改变42例(34.4%),前后循环血流动力学改变的发生率无明显差异(χ2=3.507,P=0.61)。结论脑鸣患者普遍存在血流动力学改变,甚至有脑动脉狭窄发生,TCD对脑鸣患者的病因诊断有重要的辅助作用,应作为常规检查。     

经颅多普勒对颈内动脉颅外段重度狭窄或闭塞的颅内血流动力学分析

目的研究经颅多普勒超声（TCD）对颈内动脉颅外段重度狭窄或闭塞后颅内血流动力学参数的变化，探讨其临床应用价值。方法对32例经TCD诊断为颈内动脉颅外段重度狭窄或闭塞患者，分析其双侧大脑中动脉（MCA）、大脑前动脉（ACA）、大脑后动脉（PCA）的收缩期峰值流速（PSV）及血管搏动指数（P1），判断侧支循环开放类型，并以30例正常体检人群作为对照组，所得结果进行统计学分析。结果一侧颈内动脉颅外段重度狭窄或闭塞后，其颅内血流参数与正常对照组比较，存在明显的不对称性，经统计学t检验，差异有显著意义。TCD检测侧支循环开放例数与DSA比较，经统计学X^2检验，二者无差异（P〉0．05）。结论TCD能准确地检测到颈内动脉颅外段重度狭窄或闭塞后颅内血流动力学的变化，为临床选择治疗方法及判断预后提供有价值的信息。     

TCD对糖尿病合并高血压脑血管病变的研究

目的：应用经颅多普勒超声（TCD）探讨糖尿病合并高血压患者的脑血管功能状态及血流动力学变化。方法：应用TCD检测糖尿病合并高血压患者颅内动脉，并与糖尿病组、对照组就脑动脉平均血流速度、动脉血流速度异常分布状况、血流频谱形态、搏动指数参数的结果进行统计学分析。结果：糖尿病合并高血压组颅内动脉血流速度、血流频谱形态、搏动指数异常检出率明显高于糖尿病组及对照组（P〈0.05；P〈0．001）；血流速度增快以MCA多见，血流速度减慢以椎-基底动脉为主。结论：TCD可对糖尿病合并高血压患者脑血管状态提供客观的信息，在临床诊断、治疗、预防评估中起到重要作用。     

高血压病126例经颅多普勒脑血流测定临床分析

目的　探讨经颅多普勒脑血流测定对高血压病诊断和分期的价值。方法　对 1 2 6例高血压病患者 ,采用经颅多普勒仪探测大脑中动脉、大脑前动脉及大脑后动脉 ,记录平均血流速度 ,测定结果进行统计分析。结果　高血压病 期组 ,病程较短 ,年龄较轻者 ,各颅内血管的 Vm值与对照组比较无显著差异。 期组 ,各颅内血管的 Vm值明显增快。 期组 ,病程较长 ,年龄较大者 ,各颅内血管的 Vm值明显减慢。结论　TCD测值改变提供了高血压病诊断和分期的重要辅助指标。     

温泉游泳训练对飞行员椎-基底动脉血流动力学影响的研究

目的观察健康疗养期间,温泉游泳训练对飞行员椎动脉血流动力学指标的影响。方法 24名飞行员在健康疗养期间,进行连续4周,每周5 d的温泉游泳训练。训练前后采用经颅多普勒超声仪检测椎动脉血流动力学指标。结果与训练前相比,游泳训练4周后飞行员双侧大脑后动脉(PCA)、双侧大脑椎动脉(VA)、基底动脉(BA)、收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、峰值平均血流速度(Vm),脉动指数(PI)、阻力指数(RI),训练后与训练前比较,差异有统计学意义(P<0.01)。结论健康疗养期间,温泉游泳训练可提高大脑后动脉、椎动脉、基底动脉的血流速度及血管顺应性,明显改善血流动力学指标。     

战斗机飞行员脑血流动力学的研究

目的 探讨战斗机飞行员脑血流动力学的特点.方法 试验对象分为3组：战斗机飞行员组（40名）、运输机飞行员组（30名）和健康对照组（30名）,分别用2 MHz多普勒探头检测颅内各动脉的血流速度及搏动指数.结果 战斗机飞行员组与其他两组比较,颅内动脉各期血流速度呈对称性增快,差异均有显著性意义（P＜0.01）,以大脑中动脉、大脑后动脉、椎动脉、基底动脉和眼动脉血流速度增快明显.搏动指数虽有升高,但无统计学意义.运输机飞行员组与健康对照组相比,各期血流速度差异不显著.结论 战斗机飞行员颅脑动脉高血流流速是一种代偿性生理变化,在飞行鉴定时应引起重视.     

飞行人员颅底动脉血流速度测定及正常参考值

采用Trans-Link TM-9000型经颅多普勒(TCD)检查仪,测定42名飞行人员颅底动脉血流速度,计算平均探查深度,大脑中动脉(MCA)、大脑前动脉(ACA)、眼动脉(OA)、椎动脉(VA)血流速度、收缩期峰速与舒张末血流速度比值(S/D)及脉动指数(PI)。结果提示:左、右侧血流峰速无显著差异(P>0.05);随年龄增长,血流峰速逐渐下降,S/D、PI逐渐降低。为飞行人员进行TCD检查提供了正常参考数据,为飞行人员健康鉴定提供了TCD检查的理论依据。     

大脑中动脉慢性闭塞颅内血流动力学及侧支循环的研究

<正> 大脑中动脉闭塞是引起脑梗死的主要原因之一。经颅多普勒超声(TCD)通过对颅内主要血管的检测,可准确提供颅内血管的血流动力学改变,对大脑中动脉闭塞的诊断及侧支循环的观察具有重要指导意义。1 资料与方法1.1 一般资料收集2007年3月～2010年3月经磁共振血管成像(MRA)明确诊断的大脑中动脉     

经颅多普勒观察MBRT对老年缺血性脑血管病的疗效

目的:观察离退休老干部缺血性脑血管病患者心身放松疗法(MBRT)治疗前后,经颅多普勒检查结果的变化。方法:60例缺血性脑血管病患者随机分为MBRT组和常规治疗组,疗程为8w,运用经颅多普勒检测技术评估两组的临床疗效。结果:与治疗前比较,治疗8w后,MBRT组的左侧大脑中动脉和基底动脉的收缩峰值血流速度、舒张末期血流速度、平均血流速度均显著升高,血管搏动弹性指数及脑血管阻力指数显著降低(P<0.05或<0.01);MBRT组经颅多普勒频谱改善的显效率和总有效率显著高于常规治疗组(P<0.05)。结论:MBRT组疗效优于常规治疗组,MBRT能显著增加脑血流速度、降低脑血管阻力和提高缺血性脑血管病患者的临床疗效。     

糖尿病患者的经颅多普勒变化

目的:应用经颅多普勒检查糖尿病患者颅内血管状况,以了解糖尿病与血液动力学变化的关系。方法:采用德国EME公司2020型经颅多普勒检查仪。对55例糖尿病患者及60例健康对照组进行了经颅多普勒检查,观察大脑中动脉、大脑前动脉、大脑后动脉,椎、基底动脉的血流速度,搏动指数及血流频谱进行检测。结果:55例糖尿病患者中血流速度异常占81.82%,其中血管痉挛8例,血管硬化30例,血管狭窄7例,正常10例。两组搏动指数值比较,糖尿病组搏动指数值显著高于健康对照组。结论:经颅多普勒超声检查可以较明确反映糖尿病脑血管病变的部位、范围和性质。     

旋转床模拟推拉动作对脑循环功能的影响

目的 探讨推拉动作对脑血管循环功能的影响及推拉效应的＋ＧＺ下降机制。方法１０名被试者在旋转床上经受“直立位－倒立位－直立位”Ｒ 模拟推拉动作,采用网谱勒（ＴＣＤ）技术监测分析旋转床模拟推拉脑血流速度及脉动参数的变化。结果 倒立位时出现收缩期流速增加、舒张期流速降低、脉动参数ＰＩ与ＲＩ升高的阻力增高型频谱,随后直立位时,这些变化更加明显且恢复较慢。在实验过程中平均血流速度没有显著变化。结论在推拉动作     

Transcranial Doppler ultrasound in the evaluation of collateral blood flow in patients with internal carotid artery occlusion: correlation with cerebral angiography.

PURPOSETo determine the accuracy of transcranial Doppler (TCD) ultrasound for evaluation of collateral supply through the circle of Willis in patients with internal carotid artery (ICA) occlusion.METHODSThe evaluation of the collateral pathways through the circle of Willis with TCD ultrasound and with cerebral angiography was compared in 40 patients (30 men, 10 women; mean age, 55 +/- 9 years) in a total of 44 ICA occlusions of which 43 had a suitable ipsilateral temporal bone window for TCD examination.RESULTSBy TCD, a patent anterior communicating artery is indicated by a reversal blood flow in the A1-segment of the anterior cerebral artery or by a prompt fall of blood velocity in the middle cerebral artery after compression of the nonoccluded contralateral carotid artery. In 42 of 43 instances of ICA occlusion, TCD and angiography agreed in the evaluation of a present or absent anterior communicating artery collateral supply. TCD''s sensitivity was 95%, its specificity 100%. A collateral supply through the basilar artery was assumed with TCD when there was: (a) a basilar artery blood velocity of more than 70 cm/s; (b) a marked increase of basilar artery blood velocity after compression of the nonoccluded carotid artery; (c) an evident side-to-side asymmetry of the blood velocity of the posterior cerebral arteries with high blood velocity ipsilateral to the ICA occlusion. For evaluating the collateralization via the basilar artery, TCD and angiography agreed in 37 of 40 ICA occlusions. TCD''s sensitivity was 87%, its specificity 95%.CONCLUSIONSTCD is a reliable tool for the evaluation of the collateral supply in patients with ICA occlusions.     

超声对颈动脉内膜剥除前、后颅内外血流动力学变化的评价

目的:探讨彩色多普勒血流成像(CDFI)和经颅彩色多普勒血流成像(TCCDFI)评价颈动脉内膜剥除术(CEA)治疗前、后患者颅内外动脉血流动力学的变化。方法:用CDFI和TCCDFI分别对23例颅外段颈内动脉(EICA)狭窄患者CEA治疗前、后狭窄局部管径、收缩期峰值流速(PSV)及同侧大脑中动脉(MCA)、眼动脉(OA)CEA治疗前、后PSV、搏动指数(PI)和颅内侧支循环的建立情况进行分析。结果:EICA狭窄患者CEA术后原狭窄处内径、PVS及患侧MCA、OA的PSV、PI恢复正常,侧支循环关闭。结论:CDFI与TCCDFI结合可评价颈动脉狭窄患者行CEA治疗前、后颅内外动脉的血流动力学变化,对判断CEA的疗效具有重要的临床价值。     

Brain hydrodynamics study by phase-contrast magnetic resonance imaging and transcranial color doppler

PURPOSE: To evaluate the contributions of phase-contrast magnetic resonance (PCMR) and transcranial color Doppler (TCCD) imaging in the investigation of cerebral hydrodynamics. MATERIALS AND METHODS: A total of 13 healthy subjects were studied. Blood velocity measurements were performed with TCCD and gated PCMR imaging in major intracranial and extracranial arteries stages. Peak systolic velocity and end-diastolic velocity were extracted to establish correlations between TCCD and PCMR imaging. Cerebral blood flow (CBF) and intracranial volume change (IVC) during the cardiac cycle were calculated, taking into account cerebrospinal fluid (CSF) oscillations. RESULTS: Despite an underestimation of velocities with PCMR imaging, significant correlations were observed for velocity measurements between the two modalities in extracranial vessels, but were poorly correlated in intracranial vessels. PCMR data processing gave a mean CBF of 690+/-90 mL/minute. CONCLUSION: PCMR imaging provides complementary information to TCCD to assess various intracranial parameters such as instantaneous velocities, blood and CSF flow distributions, volume variation, or pressure regulation mechanisms during cardiac cycles.     

血管内支架成形术治疗颅内动脉狭窄28例

目的探讨血管内支架成形术治疗颅内动脉狭窄的临床效果和安全性。方法 2006年7月—2010年12月,采用经皮血管内支架成形术治疗颅内狭窄28例。结果治疗狭窄颅内动脉28支,其中置入冠脉球扩式支架16枚,Wingspan支架6枚,apollo支架6枚,支架不能到位,放弃手术1例。27支动脉狭窄程度均明显改善,狭窄程度由原来的(89.36±5.63)%下降至(4.23±1.57)%,无死亡病倒,术后27例患者症状均明显改善,1例基底动脉重度狭窄患者术后出现一侧肢体麻木的并发症,1例术后出现脑栓塞表现,3 d后恢复正常,其他26例患者无并发症,随访2～12个月,无短暂性脑缺血发作(TIA)发作,随访患者经颅多普勒超声(TCD)结果显示,原狭窄血管近端、远端血流速度和支架置入后24 h的TCD结果无明显差别。结论血管内支架成形术是治疗症状性颅内动脉狭窄的安全、有效的方法,临床效果好,并发症少。适应证的正确选择、术中熟练的导管导丝技术和围术期的专业处理是手术成功的关键,但其远期疗效还需要长期随访。     

彩色多普勒血流成像在检测子宫动脉栓塞术前后卵巢血流变化中的应用

目的 应用彩色多普勒血流成像技术(CDFI)从血液动力学水平了解子宫动脉栓塞术(UAE)对卵巢血供的影响.资料与方法 32例妇科良性疾病患者子宫动脉栓塞术前及术后1周、术后1个月和术后3个月分别用彩色多普勒血流成像技术测量子宫及卵巢动脉的血流变化参数,包括收缩期血流速度峰值(PSV)、舒张期末血流速度(EDV)及阻力指数(RI).结果 32例患者手术成功率为100％,术后所有患者临床症状均得到改善;栓塞前后卵巢动脉PSV、EDV及RI比较,差异无统计学意义(P＞0.05);栓塞前后子宫动脉PSV、EDV及RI比较,差异有统计学意义(P＜0.01).结论 子宫动脉栓塞术治疗妇科良性疾病是一种安全、有效的治疗方法,彩色多普勒血流成像技术可作为妇科良性疾病手术前后的检测方法,用来评价子宫动脉栓塞术的临床疗效.     

Doppler spectral waveform analysis of arteries of the hand in patients with Raynaud's phenomenon as compared with healthy subjects.

OBJECTIVE: We sought to characterize and compare the blood flow patterns of peripheral arteries of the hand in patients with Raynaud's phenomenon and in healthy subjects. SUBJECTS AND METHODS: We used Doppler sonography to assess the blood flow pattern of the proper palmar digital artery and the deep radial arch in the hands of 79 healthy subjects and 24 patients with primary and secondary Raynaud's phenomenon. We determined the resistive index, pulsatility index, peak systolic velocity, and end-diastolic velocity of these peripheral arteries at rest and after cold immersion. RESULTS: The proper palmar digital artery of healthy subjects showed higher end-diastolic velocities and lower resistive indexes than did the deep radial arch. Compared with healthy subjects, patients with Raynaud's phenomenon had higher resistive and pulsatility indexes but lower peak systolic and end-diastolic velocities in these arteries. Accordingly, the differences in end-diastolic velocity and resistive index seen in the two peripheral arteries of healthy subjects were not seen in patients with Raynaud's phenomenon. Analysis of receiver operating characteristic curves showed high diagnostic accuracy in detecting the disease. Cold-immersion studies revealed that for the proper palmar digital arteries throughout the time after immersion, all these Doppler parameters were significantly lower for the velocities and higher for the indexes in patients with Raynaud's phenomenon than in healthy subjects. CONCLUSION: Taken together, these results suggest a legitimate role for Doppler sonography in the assessment of Raynaud's phenomenon.