经颅多普勒超声在椎-基底动脉缺血性眩晕诊断中的应用价值

中老年椎-基底动脉缺血性眩晕，神经系统查体及CT、MRJ等检查多不能获得满意结果。经颅多普勒超声(TCD)能无创伤地穿透颅骨，直接获得颅内动脉的血流动态信息，对研究椎-基底动脉缺血性眩晕有独特的使用价值。我科自1998年10月至2000年3月随机选择120例椎基底动脉缺血性眩晕患者和50例健康中老年人作对照，用二维TCD进行颅内动脉检查，现介绍如下：     

经颅彩色多普勒超声诊断颅内段椎-基底动脉狭窄的应用价值

目的探讨经颅彩色多普勒血流显像（TCDFI）诊断颅内段椎-基底动脉狭窄（VBS）的艋床价值。方法选择颅内段VBS所致的短暂性脑缺血发作患者40例，用二维超声探头经枕窗探查颅内段椎-基底动脉（VBA），观察血管充盈情况及血流动力学变化，部分较重者进行数字减影血管造影（DsA）检查对比。结果病例组和对照组血流充盈情况及频谱形态明显不同，收缩期峰值流速（PSV）和搏动指数（PI）差异具有显著性（P〈0．05或P〈0．01）。并得出TCDFI诊断VBS的敏感性为85．7％，特异性为83．3％。结论TCDFI能清晰、直观地检出颅内VBA有无狭窄及其程度，提供有价值的血流动力学参数，作为筛选VBS的首选方法。     

偏头痛经颅多普勒超声与瞬目反射检查

目的探讨偏头痛血管舒缩功能障碍和神经功能障碍的关系。方法对42例偏头痛发作期和32例间歇期患者进行经颅多普勒超声(TCD)和瞬目反射(BR)检测。结果偏头痛发作期和间歇期大脑中动脉(MCA),大脑前动脉(ACA),大脑后动脉(PCA)及椎基底动脉(VA、BA)的平均血流速度(Vm)明显高于正常对照组(P<0.01),发作期的ACA、BA、VA的Vm明显高于间歇期(P<0.05);两期Vm异常率比较具有显著差异(P<0.05)。BR检测提示脑干功能障碍和三叉神经传入通路、面神经传出通路功能障碍,发作期34例(81%),间歇期24例(75%),两期异常率比较无显著差异(P>0.05)。结论偏头痛患者存在着脑干和以三叉神经为主的神经功能障碍,这很可能是造成血管舒缩功能障碍引起偏头痛发作的原因。     

经颅多普勒超声对椎-基底动脉流速减慢的分析与探讨

目的通过经颅多普勒超声(TCD)检测椎-基底动脉,对平均血流速度(Vm)减慢病例进行分析,探讨引起椎-基底动脉Vm减慢的真正原因。方法对156例椎-基底动脉Vm减慢(至少一侧椎动脉Vm低于25cm/s或基底动脉Vm低于30cm/s)患者与椎-基底动脉血管CT(CTA)或血管造影(DSA)对照分析。结果156例患者中,椎-基底动脉正常者,18.6%;双椎动脉发育不对称者,17.3%;一侧椎动脉狭窄者,16.0%;双侧椎动脉狭窄者,19.2%;一侧椎动脉闭塞者,14.8%;一侧狭窄一侧闭塞者,9.0%;基底动脉狭窄者,5.1%。结论TCD在检测椎-基底动脉狭窄过程中发挥了不可替代的作用。     

经颅多普勒超声检查在椎动脉型颈椎病中的诊断价值

本文采用配对设计研究方法，对４１例椎动脉型颈椎病（ＣＳＡ）住院患者进行经颅多普勒超声（ＴＣＤ）检测分析。结果发现ＣＳＡ组，ＴＣＤ检测异常率为６８．２９％，统计学处理，其椎动脉及基底动脉的收缩期峰值血流速度及平均血流速度均较正常对照组显著减慢（Ｐ＜０．０１～０．００１）。这证实ＣＳＡ患者存在椎基底动脉供血不足，亦表明ＴＣＤ检测能够为ＣＳＡ的诊断提供血流动力学变化的客观依据。本文还发现，ＣＳＡ组ＴＣＤ检测正常者转头状态下ＴＣＤ频谱显示有椎基底动脉供血不足改变，这表明转头可使其椎动脉的刺激和压迫加重，提示对ＣＳＡ患者尚需考虑不同头位的ＴＣＤ检测。部分ＣＳＡ患者的ＴＣＤ检测，其椎动脉和基底动脉呈动脉硬化性改变，但统计学处理其血管搏动指数与正常对照组比较无显著性差异（Ｐ＞０．０５），提示ＴＣＤ检测尚不能代替临床血压，血脂，眼底动脉及心电图等检查指标。     

经颅多普勒超声在老年椎基底动脉缺血性眩晕诊断中的应用价值

目的:探讨经颅多普勒超声(TCD)在老年椎基底动脉缺血性眩晕诊断中的应用价值.方法:选取160例疑似椎基底动脉缺血性眩晕患者为研究对象,评估TCD诊断椎基底动脉缺血性眩晕的灵敏度、特异度、准确度、Kappa值,以数字减影血管造影(DSA)检查结果为"金标准",分为阳性组(n=87)与阴性组(n =73).比较两组患者血...     

彩色多普勒及经颅多普勒超声结合诊断锁骨下动脉盗血的意义

目的：探讨锁骨下动脉盗血的经颅多普勒及彩色多普勒超声表现，分析锁骨下动脉盗血综合征（SSS）的病因、血流动力学、频谱特点、狭窄程度与盗血的关系等问题，评价超声诊断价值。方法：彩色多普勒二维超声常规显示颈动脉、椎动脉的内径及内膜情况，对椎动脉疑有盗血频谱的患者再结合用彩色多普勒检测锁骨下动脉及无名动脉的内膜情况、血流方向及速度，结合TCD对椎基底动脉的血流参数、血流方向、频谱图形进行检测。结果：锁骨下动脉盗血时患侧椎动脉出现血流方向逆转，基底动脉呈双向血流的特定盗血频谱图形。15例SSS患者中，动脉硬化及大动脉炎所致各为13例和2例，锁骨下或无名动脉狭窄或闭锁，可引起部分性及完全性盗血。椎动脉峰值血流速度健侧明显高于患侧。结论：SSS最常见病因为动脉硬化和大动脉炎。完全性与部分性盗血与血管狭窄程度有关。彩色多普勒与经颅多普勒相结合能更准确地对SSS做出诊断。     

经颅彩色多普勒超声联合经颅超声造影诊断颅内椎-基底动脉狭窄闭塞的价值

目的探讨经颅彩色多普勒超声（TCCS）联合经颅超声造影诊断颅内椎-基底动脉狭窄闭塞的特征及准确性。方法对35例疑有椎-基底动脉狭窄闭塞的患者应用TCCS联合经颅超声造影经枕窗检查椎-基底动脉,同时与数字减影血管造影（DSA）比较。结果35例患者DSA检出椎-基底动脉狭窄29支,TCCS联合经颅超声造影检出椎-基底动脉狭窄24支。与DSA检查对照,TCCS联合经颅超声造影诊断椎-基底动脉狭窄的差异无统计学意义（P〉0．05）,其诊断敏感性为79131％,特异性为98．68％,阳性预测值为95．83％,阴性预测值为92．59％。结论TCSS联合经颅超声造影能有效评估颅内椎-基底动脉的血流变化,可以作为大部分颅内椎-基底动脉狭窄闭塞病变的首选筛查手段。     

天麻素治疗椎基底动脉供血不足眩晕经颅多普勒临床观察

目的观察天麻素注射液治疗椎基底动脉供血不足（VBI）眩晕的临床疗效及TCD变化。方法82例VBI眩晕患者随机分成观察组和对照组，观察组每日静滴天麻素注射液0．2g（昆明制药厂生产），对照组每日静滴丹参注射液20ml。疗程2周，对比观察其临床疗效与TCD变化。结果观察组在TCD改变起效时间、临床疗效均优于对照组（P〈0.05或0．01）。结论天麻素治疗VBI眩晕安全有效，TCD可作为观察指标之一。     

眩晕症经颅多普勒检测的诊断价值

眩晕症经颅多普勒检测的诊断价值许月珍，王景祥，朱文军，全丽娟１资料与方法本组１９４例为我院门诊及住院病人，均有一过性或阵发性眩晕史。男９６例，女９８例，年龄最小１７岁，最大８０岁，平均４７．２岁。其中１７～４０岁５９例，４１～８０岁１３５例。仪器用美...     

颅内静脉血流的经颅多普勒超声研究

目的　采用经颅多普勒（ＴＣＤ） 评价颅内静脉血流。方法　应用２ ．０ ＭＨｚ 探头对８０ 例健康人颅内静脉行多普勒检测,年龄２０ ～７０ 岁（ 平均４８ ．９ 岁） 。结果　基底静脉血流信号背离探头,邻近大脑后动脉,平均流速（１３ ．６ ±２ ．２） ｃｍ ／ｓ ,并随年龄增长有减低趋势,两侧血流速度无明显差异。３４ ％ 的受试者发现大脑中深静脉,血流信号背离探头,与大脑中动脉并行,血流速度与基底静脉类似。直窦血流信号朝向探头,平均流速（１７ ．３±４ ．２） ｃｍ／ｓ 。结论　经颅多普勒可用于评价脑底静脉血流。     

经颅超声诊断帕金森病

目的 探讨经颅超声(TCS)诊断帕金森病(PD)的临床应用价值。方法 随机选取478例临床确诊的神经变性疾病患者(病例组),根据诊断标准分为PD、帕金森叠加综合征、继发性帕金森综合征及原发性震颤亚组;另选取同期124名正常志愿者作为对照组。应用TCS盲法测量黑质(SN)高回声面积,比较各组SN高回声阳性率及SN高回声面积差异,计算TCS诊断PD的敏感度及特异度。对PD亚组患者进行急性多巴反应试验,比较SN高回声阳性率与多巴反应试验阳性率的差异。结果 TCS的中脑显示率为81.72%(492/602),剔除中脑显示不清者后,病例组入组389例,其中PD患者170例,对照组103名。PD亚组SN高回声阳性率和SN高回声面积均明显高于其余各组(P均<0.01)。TCS诊断PD的敏感度为81.76%(139/170),特异度为77.64%(250/322)。PD亚组多巴反应阳性率与SN高回声阳性率差异无统计学意义(P>0.01)。结论 SN高回声为PD的典型TCS特征,对于诊断PD具有重要应用价值。     

经颅黑质超声诊断帕金森病的临床评价

目的 通过对帕金森病患者及正常对照组进行经颅超声(transcranial sonography,TCS)检查,结合帕金森病患者的Hoehn Yahr（H Y）分级及帕金森病统一评分量表评分结果,了解我国大陆地区帕金森病患者有无黑质(substantia nigra, SN)回声增强表现。方法 对入选对象进行TCS检查,并对检查结果进行评价。结果 帕金森病患者 SN阳性率明显高于正常对照者（P＜0.05）。帕金森病SN异常组 H Y 分期明显高于帕金森病SN正常组(P＜0.05),表明帕金森病患者SN高回声面积与H Y分期相关。TCS检查对帕金森病的敏感性为80.5%,特异性为79.9%。结论 我国帕金森病患者SN强回声检出率显著高于对照组,说明我国帕金森病患者也存在SN回声增强这一现象,与国内外报道相一致。TCS检查对帕金森病的诊断具有一定的意义,敏感性及特异性较高。     

经颅多普勒超声对基底节区脑出血动态监测的临床意义

经颅多普勒超声 (TCD)通常用来评价脑梗塞和蛛网膜下腔出血患者的颅内血管的血流动力学改变 ,脑出血后颅内压升高 ,亦引起脑血流动力学的改变 ,但TCD评价脑出血患者的临床意义尚存在争议 ,我们对 4 0例基底节区脑出血患者进行TCD检测 ,报告如下。1　资料与方法1.1　对象　脑出血患者 4 0例 ,其中男 2 2例 ,女 18例 ,年龄37～ 80岁 ,平均 (5 6± 13)岁 ,均符合 1996年中华神经科学会、中华神经外科学会制定的脑出血的诊断标准[1] ,并经头颅CT证实为基底节区出血 ,于脑出血发病 1～ 3天内行TCD检查 ,2周后复查。1.2　方法　采用床边TCD…     

Transcranial Doppler sonography: anatomical landmarks and normal velocity values

Until recently, both the diagnosis of intracranial occlusive disease of the large brain arteries, as well as intracranial flow abnormalities due to extracranial arterial lesions, have been a "blind spot" for ultrasound techniques. With the advent of transcranial Doppler sonography (TCD), however, a broad spectrum of potential clinical and scientific applications of TCD to the intracranial vasculature has been advocated. In order to achieve an informative insonation of vessels and a correct interpretation of findings, knowledge of both anatomical landmarks within the skull and flow characteristics of distinct vessel segments are necessary. This paper presents such data elaborated from 64 carotid and 42 vertebral angiograms, 40 contrast-medium enhanced CT scans demonstrating the circle of Willis, 122 normal sagittal MRI scans of the brainstem, 40 cadaver skulls, 38 fresh cadavers, 106 normal volunteers and 59 patients with subclavian steal mechanisms. The main findings were as follows: The inner internal carotid artery bifurcation, the M1-segment of the middle cerebral artery, the C3-segment of the carotid siphon, the vertebral artery junction and the top of the basilar artery were found at insonation depths of 60.4 +/- 7, 40 +/- 8 to 60.4 +/- 7, 62 +/- 4, 84 +/- 8 and 108 +/- 8 mm, respectively. Normal mean flow velocities within the M1-segment, the posterior cerebral artery, the carotid siphon and the basilar trunk were 58 +/- 15.6, 39 +/- 9.9, 47 +/- 13.8 and 41 +/- 10 cm/s, respectively, and revealed a marked decrease with age. Intraindividual side-to-side differences were low. Vertebrobasilar data from measurements of neuroradiological material closely met in vivo findings in normals and patients. Criteria for the identification of various vessel segments are provided. On the basis of these findings, a topographical orientation within the skull should be possible in order that beginners commence TCD accurately. Normative velocity data are helpful for differentiating normal and pathological flow conditions at different ages.     

多发性脑梗塞性痴呆与Alzheimer氏痴呆的经颅多普勒研究

用ＴＣＤ对２８例多发性脑梗塞性痴呆（ＭＩＤ）和２４例Ａｌｚｈｅｉｍｅｒ氏痴呆（ＡＤ）进行了研究。结果表明ＭＩＤ患者的Ｖｍ、Ｖｄ、ＥＰＲ低于对照组，ＰＩ高于对照组；ＡＤ患者的各项指标与对照组无差异，ＡＤ与ＭＩＤ比较，除ＥＰＲ外其余各项指标都没有差异。ＲＤＣ曲线分析表明以－１ｃｍ／ｓｅｃ的ＥＰＲ临界点可鉴别ＡＤ与ＭＩＤ。     

Transcranial Doppler sonography in the early stage of critical enteroviral infection.

OBJECTIVE: There is a high fatality rate in enteroviral infection with central nervous system involvement. Our aim was to investigate the change in intracranial blood flow to disclose the characteristic findings in the early stage of critical enteroviral infection. METHODS: We examined 27 patients in critical condition with enteroviral infection in our pediatric intensive care unit. We performed transcranial Doppler sonography within 12 hours of admission to the unit. The data were compared with those of a group of 11 patients with nonenteroviral encephalitis. RESULTS: The peak systolic, end-diastolic, and mean velocities of the critical enteroviral infection group were significantly higher than those of the control group (P < .05). Gosling pulsatility index and Pourcelot resistive index values for the right and left middle cerebral arteries (pulsatility index, [mean +/- SD], 0.68 +/- 0.22 and 0.77 +/- 0.19, respectively; resistive index, 0.48 +/- 0.01 and 0.52 +/- 0.01) in patients with critical enteroviral infection were significantly lower than those of patients with nonenteroviral encephalitis (pulsatility index, 1.10 +/- 0.30 and 0.98 +/- 0.22; resistive index, 0.62 +/- 0.01 and 0.60 +/- 0.01; P < .05). CONCLUSIONS: Low pulsatility index and resistive index values for cerebral blood flow were observed in the early stage of critical enteroviral infection. This characteristic finding of cerebral blood flow might be associated with the increased sympathetic discharge induced by a brain stem-involved systemic inflammatory response and dysfunction of autoregulation caused by the infection or other disorders of autoregulation that might cause severe or fatal complications.     

经颅彩色多普勒超声评价外伤性蛛网膜下腔出血患者大脑中动脉血管痉挛

目的探讨经颅彩色多普勒超声(TCCS)在评价外伤性蛛网膜下腔出血患者大脑中动脉痉挛程度中的作用。方法对经CT确诊的外伤性蛛网膜下腔出血患者100例,采用TCCS观察大脑中动脉彩色血流束的走行、方向、有无局部充盈缺损和色彩混叠,频谱多普勒检测大脑中动脉收缩期峰值血流速度(VMCA)及同侧颈内动脉入颅段的血流速度(VICA),计算Lindegaard指数=VMCA/VICA。检查时间分别在脑外伤后1~3d、10d、14d,每次均测量3次取平均值。根据有无脑血管痉挛症状,分为有症状和无症状组,并对两组血流参数进行比较分析。结果外伤后3~7d蛛网膜下腔出血患者开始出现不同程度的脑血管痉挛症状,以6~10d最显著,2周以后逐渐减轻,其中外伤后10d35例符合大脑中动脉痉挛的诊断标准;有症状组VMCA和Lindgaard指数明显大于无症状组(P<0.01或P<0.05)。结论TCCS检测外伤性蛛网膜下腔出血患者的大脑中动脉VMCA和Lindgaard指数可以很好地了解大脑中动脉痉挛程度。     

Power Doppler sonography in the diagnosis of Graves' disease.

In addition to color and pulsed Doppler sonography findings, we aimed to describe power Doppler sonography findings in Graves' disease in this study. Twenty-three patients with Graves' disease were imaged with gray-scale, color and power Doppler sonography. Twenty normal volunteers were examined by the same equipment and the same technique as a control group. A subjective grading system was used to categorize the vascularization in pulsed Doppler sonography images from normal to markedly increased vascularization. Power Doppler sonography exhibited diffuse hypervascularity in the thyroid gland in all patients. The flow was covering about all the parenchyma. Four patients showed mild, 12 patients moderate and seven patients marked vascularity. The intensity of power Doppler flow pattern was not correlated with the severity of the disease. This study demonstrated that power Doppler sonography is a convenient, time saving, inexpensive and noninvasive method as compared with isotope scan and some other laboratory tests for confirmation of Graves' disease.