经颅多普勒对颅内感染患者颅内压和脑灌注压的预测价值

目的 探讨经颅多普勒（TCD）频谱参数对颅内感染患者颅内压（ICP）和脑灌注压（CPP）的预测价值。方法 对42例颅内感染患者进行的128次腰穿测压前行TCD检查,对TCD资料及脑脊液压力进行分析,并与对照组比较。结果 颅内感染组患者随着ICP升高,TCD表现出高阻力血流频谱,波形普遍变尖,收缩期血流（Vs）无明显变化,舒张期血流（Vd）减慢,搏动指数（PI）增大。与对照组比较血流速度明显增快。根据TCD参数及预测ICP（ICPe）及预测CPP（CPPe）的回归方程,ICPe及CPPe值与实测的ICP、CPP值呈正相关（r=0．594、0．910,均P〈0．001）。结论 TCD频谱参数可较准确预测颅内感染患者ICP、CPP的变化。     

经颅多普勒对脑出血患者颅内压和脑灌注压的预测研究

目的探讨经颅多普勒超声(transcranial doppler,TCD)血流动力学参数对脑出血患者颅内压(intracra-nial pressure,ICP)和脑灌注压(cerebral perfusion pressure,CPP)的预测价值。方法对45例脑出血患者138次腰穿前行TCD检查(发病第1、3天常规进行),对TCD资料及脑脊液压力进行分析。结果与对照组比较,脑出血颅高压患者TCD表现出高阻力血流频谱,随着ICP升高,收缩期血流速度(Vs)、平均血流速度(Vm)无明显变化,舒张期血流速度(Vd)减低,血管搏动指数(PI)升高。与健侧比较,出血侧Vs、Vm、Vd均显著降低,PI显著升高(P<0.01)。与小量出血组比较,发病第3天,中、大量出血组的Vm、Vd均显著降低,PI值显著增高(P均<0.05)。与发病第1天比较,发病第3天中、大量出血组Vm、Vd均显著降低,PI显著升高(P均<0.05)。根据出血侧血流动力学参数所得预测颅内压(ICPe)及预测脑灌注压(CPPe)的回归方程分别为:ICPe=-7.096 20.474PI 0.053MAP;CPPe=7.096-20.474PI 0.947MAP。预测和实测的ICP、CPP显著正相关(r=0.796、0.977,P均<0.01),预测差值在5mm Hg内阳性预测率均为89.9%。结论依据出血侧TCD血流动力学参数可较准确预测脑出血患者的ICP、CPP。     

脑静脉窦血栓经颅多普勒超声监测的临床意义

目的探讨经颅多普勒超声(TCD)监测上矢状窦血栓患者颅内压(ICP)的可行性,研究TCD动脉、静脉参数及频谱形态与ICP的关系,以指导临床治疗、评价疗效及判定预后。方法选择18例上矢状窦血栓形成住院患者,取入院第1、7及14天为观察点,动态监测患者的ICP、脑灌注压(CPP)、波动指数(PI)、阻力指数(RI)、大脑中动脉(MCA)和大脑中深静脉(dMCV)平均血流速度(Vm)以及TCD频谱形态,并与对照组相比较,同时进行相关性分析。结果上矢状窦血栓患者各观察点参数与对照组相比均有显著性差异(t=6.32,P<0.05),随着ICP的升高,患者的dMCV平均血流速度、PI及RI呈上升趋势,MCA平均血流速度和CPP呈下降趋势,在第7天达到高峰,持续到两周时略有恢复,但仍维持在较高水平。ICP与P1呈明显正相关(P<0.01,r=0.859);ICP与MCA-Vm呈明显负相关(P<0.01.r=-0.638);ICP与dMCV-Vm无相关性(r=0.07,P>0.05)。随着ICP的升高,动脉频谱表现为舒张期和收缩期血流的不同步下降,静脉频谱呈现血流升高的特征,表现为血流量与血管径的同步增加。结论TCD对临床可疑脑静脉窦血栓形成的患者是一种有效的筛选检测手段,TCD动态监测脑静脉窦血栓患者动脉和静脉血流的同步变化可以评估ICP增高的程度和脑部灌注情况,为临床治疗提供科学依据。     

体感诱发电位及运动诱发电位对脊髓型颈椎病患者脊髓功能的诊断价值

目的探讨体感诱发电位(somatosensory evoked potentials,SEP)及经颅电刺激运动诱发电位(motor evoked potentials,MEP)对脊髓型颈椎病患者脊髓功能的诊断价值。方法利用诱发电位仪对31例脊髓型颈椎病患者术前、术后SEP及MEP检测,分别记录SEP、MEP潜伏期及相应的波幅值,并与临床症状改善情况进行比较。结果 31例患者中术前SEP、MEP异常率分别为90.3%(28例)、54.8%(17例),4周检测异常率分别为35.3%(11例)、19.4%(6例)。与正常组比较,患者组潜伏期和波幅差异有统计学意义(P0.05)。与患者术前比较,术后4周的潜伏期和波幅改善差异有统计学意义(P0.05),与临床表现的改善相关(P0.05)。患者中SEP和MEP潜伏期及中枢传导时间(CMCT)均异常时,其临床表现较重。结论 SEP和MEP相结合可以判断脊髓功能受损的严重程度,为脊髓型颈椎病提供客观诊断及预后依据。     

神经外科手术期间体感诱发电位变化的研究

目的　研究神经外科手术期间体感诱发电位 (SEP)的变化 ,以期为麻醉和手术处理提供依据 ,评估疗效 ,判断预后。方法　对 17例神经外科手术患者于术前、麻醉、术始、术中、术毕和术后六个时程连续监测SEP ,探讨全麻及手术操作对SEP的影响。结果　麻醉后SEP潜伏期延长 5 .96 %,波幅下降 2 4 .0 0 %,未出现波形消失者 ;SEP可监测手术中脑缺血及脊髓功能的变化。结论　麻醉期间脑电活动受到抑制 ,SEP出现潜伏期延长和波幅下降 ,未出现波形消失者 ;SEP可用于手术操作的监测 ,尤其是涉及躯体感觉传导通路的手术     

躯体感觉诱发电位在糖尿病性脊髓病中的应用

目的探讨躯体感觉诱发电位(SEP)与糖尿病合并深感觉障碍的关系,揭示SEP对糖尿病合并深感觉障碍的定位价值,并将诱发电位结果与神经传导(NCV)测定结果进行比较,分析二者在糖尿病性神经系统病变中的关系。方法对52例糖尿病患者及40例正常人进行双侧胫神经躯体感觉诱发电位测定,对两组SEP各波潜伏期及波幅的均值进行t检验。同时对52例患者均进行双下肢周围神经传导速度测定,结果与SEP进行对比分析。结果 2组SEP的P40潜伏期及波幅比较差异有统计学意义(P<0.01),N9波幅及潜伏期比较差异无统计学意义(P>0.05),SEP与NCV不相关(P>0.05)。结论 SEP为糖尿病并发深感觉障碍中枢段病变提供了早期诊断的客观依据,SEP与NCV检测不相交。     

α2-去甲基肾上腺素能受体对异丙酚麻醉下大鼠SEP的调节

目的探讨大鼠异丙酚麻醉中α2-去甲基肾上腺素能(NA)受体调节剂对皮层躯体感觉诱发电位(SEP) N20波的影响.方法将SD雄性大鼠30只随机分为3组.单纯异丙酚A组:微量泵以异丙酚10 mg/kg/h、60mg/kg/h的速度依次各静注45 min,停止静注异丙酚直至动物清醒.B组和C组在输注异丙酚的同时腹腔内分别注射可乐定和育亨宾各0.5 mg/kg.分别监测麻醉前、中及苏醒期的皮层SEP N20波的潜伏期和波幅.结果与基础值相比,3组药物对SEP N20波潜伏期均无显著影响;A组对SEP N20波的波幅无影响, B组降低SEP N20波的波幅, C组则增加了SEP N20波的波幅.结论异丙酚麻醉下α2-NA受体激动剂和抑制剂所引起SEP N20波波幅变化可能与镇痛机制有关.     

经颅多普勒与闪光视觉诱发电位预测颅内感染患者颅内压的临床应用价值

目的探讨经颅多普勒(TCD)与闪光视觉诱发电位(FVEP)预测颅内感染患者颅内压(ICP)的临床应用价值。方法对65例颅内感染患者(颅内感染组)及30例非颅内感染患者(对照组)腰穿测压前分别行TCD及FVEP检查,分析ICP与TCD血流动力学参数、FVEP各波潜伏期的相关性;比较两种方法预测ICP的准确性。结果颅内感染组共行182例次腰椎穿刺检查,ICP正常42例次,轻度增高80例次,中度增高60例次;发现脑血管痉挛(CVS)84例次。与对照组比较,颅内感染组ICP明显增高;随着ICP增高,TCD的舒张期血流(Vd)减慢,博动指数(PI)增加;FVEP的P2、N2、P3、N3潜伏期延迟越明显;ICP与PI及N2潜伏期相关性最大(r=0.612,r=0.708,均P=0.000)。当预测ICP值(ICPe)与ICP差值<5 mmHg时,ICPeFVEP的准确性(78.6%)明显优于ICPeTCD(65.9%)(P<0.01);患者伴有CVS时,ICPeFVEP的准确性明显高于ICPeTCD(P=0.000)。结论 TCD及FVEP均可用于临床无创预测ICP,但ICPeFVEP准确性更高。     

椭圆形瞳孔的临床表现与高颅压的关系

作者在2年过程中观察141例急性脑外伤、蛛网膜下腔出血和脑内出血患者,发现15例曾出现椭圆形瞳孔,并连续记录了该瞳孔和ICP的关系以及瞳孔对ICP升高治疗的反应.15例中有13例当首次出现椭圆形瞳孔时ICP是在22～38mmHg之间,1例行硬脑膜外血肿清除术后脑组织肿胀,骨瓣不能复原,当ICP在18mmHg时即出现椭圆形瞳孔.另1例在头外伤后1小时出现椭圆形瞳孔,当时ICP低于10mmHg其瞳孔改变与颅压无关.14例ICP升高中的9例,其异常瞳孔与ICP升高有关,当ICP下降到20mmHg以下时,该瞳孔均恢复到正常形状和大小.有4例ICP未得到理想控制,其     

重复经颅磁刺激对精神分裂症患者事件相关电位的影响

目的:探讨重复经颅磁刺激(rTMS)对精神分裂症患者失匹配负波(MMN)及P300的影响。方法:应用美国脑电生理仪器,对78例精神分裂症患者在rTMS治疗前后进行P300和MMN检测,观察rTMS治疗前后P300和MMN的变化。结果:与正常组比较,精神分裂症组MMN潜伏期延迟,和波幅降低(P0.05或P0.01),P300中的靶波幅P3降低(P0.05)。患者组经过25次rTMS治疗后MMN波幅及P300靶波幅P3明显提高(P0.05或P0.01)。结论:rTMS治疗可以提高精神分裂症患者事件相关电位的MMN及P3波幅。     

Predictability of intracranial pressure oscillations in patients with suspected normal pressure hydrocephalus by transcranial Doppler ultrasound

Abstract

Intracranial pressure (ICP) was monitored continuously for one night in 36 patients with suspected symptomatic normal pressure hydrocephalus (NPH) to identify patients who might benefit from subsequent shunting. In 33 of these patients middle cerebral artery (MCA) blood flow velocity by means of transcranial Doppler sonography (TCD) and ICP were recorded simultaneously. ICP B-waves always paralleled changes in the TCD signal (TCD B-wave equivalents). The relative frequency of ICP B-waves was predictable by TCD, albeit slightly underestimated due to a generally lower relative amplitude of the TCD B-wave equivalents. However; the same TCD B-wave equivalent amplitude could be accompanied by quite different ICP changes in different patients. Considering the baseline values in the absence of pressure wavesthere was no significant relationship between ICP and TCD resistance index (Pourcelot) in different patients. Raising ICP by injection of 10 ml saline into the ventricle, however was accompanied by an increased TCD resistance index in the individual patient. As the relative frequency of B-wave activity is assumed to be an indicator for shunt responsiveness, continuous TCD monitoring can be used as a screening procedure to detect the presence and the relative frequency of B-wave activity in patients with suspected NPH. However, since neither the absolute ICP nor the amplitude of spontaneous oscillations can be predicted, TCD monitoring is not suitable to replace ICP monitoring. [Neurol Res 1994; 16: 398-402]     

颅内压增高及甘露醇治疗患者的脑血流动力学变化

目的　研究颅内压增高患者的脑血流动力学变化特征 ,并探讨TCD和甘露醇对患者的诊断治疗作用。方法　对 4 0例颅内压增高患者进行TCD检测 ,其中 15例行甘露醇治疗前后动态观察。结果　颅内压增高患者脑血流速度 (Vd ,Vs)减慢 ,血管阻力参数值 (PI ,RI)增大 ,甘露醇治疗后各检测参数明显改善 ,并以舒张期流速及脉动指数为著。结论　根据脑血流动力学的特征性改变 ,结合试验性甘露醇治疗 ,TCD为无创性诊断和动态观察颅内压增高提供了依据     

Evaluation of intracranial pressure from transcranial Doppler studies in cerebral disease

Summary The extent to which estimations of intracranial pressure can be derived from intracranial flow patterns was studied. The blood flow velocity in the middle cerebral artery was recorded with the EME TC 2–64 transcranial Doppler (TCD) device in 26 patients suffering from various severe cerebral diseases. Simultaneously the mean intracranial pressure (ICP) was measured by means of an epidural device. Arterial carbon-dioxide tensions were monitored by blood gas analysis. In all patients it was observed that the middle cerebral artery flow patterns changed distinctly when the ICP increased; these changes were distinguished by a decrease of the mean flow velocity and an increase of the Pourcelot index. A good correlation between the ICP and the flow parameters (especially the product mean systemic arterial pressure × Pourcelot index/mean flow velocity) was found in a select group of 13 patients, in whom comparable initial conditions existed and in whom additional parameters influencing the TCD recordings could be kept constant (r=0.873; P<0.001).Supported by the Deutsche Forschungsgemeinschaft (SFB 330 — Organprotektion)     

去骨瓣减压术后经颅多普勒参数与颅内压相关性研究

目的探讨去骨瓣减压术后经颅多普勒(TCD)参数与颅内压(ICP)相关性及临床意义。方法应用TCD检测52例去骨瓣减压术后次日患者的双侧脑血流,并与即时ICP进行相关性分析。结果①随着ICP的变化,TCD频谱图像表现为高阻波形,参数平均血流速度(Vm)呈下降趋势,搏动指数(PI)呈上升趋势;②健侧与患侧TCD参数不同,具有统计学差异(P<0.01)。结论去骨瓣减压术后次日TCD参数与ICP存在密切相关性,TCD结果提示颅内存在压力差,初步阐明无创TCD在神经外科急症术后监测中发挥重要的作用。     

经颅多普勒超声联合体感诱发电位监测在颈动脉内膜剥脱术中的应用价值

目的探讨经颅多普勒超声(TCD)联合体感诱发电位(SEP)监测在颈动脉内膜剥脱(CEA)术中的应用价值。方法对29例颈动脉狭窄患者在CEA术中采用TCD和SEP联合监测,用TCD监测术侧大脑中动脉(MCA)平均血流速度(Vm)的变化,并记录同时段SEP波幅的变化。根据术中TCD和SEP的变化综合判断是否实施转流术,并判断开放颈动脉后有无出现脑血流高灌注。结果本组患者经术中应用TCD和SEP联合监测均顺利完成手术;3例TCD监测MCA Vm及SEP波幅下降均达到转流标准的患者,术中行转流术。SEP(10.3%,3/29)和TCD(44.8%,13/29)监测达到转流标准比率的差异有统计学意义(χ2=4.118,P=0.002)。5例患者TCD监测示术中出现脑血流过度灌注,但此时SEP并无阳性表现,通过适当降血压及压迫颈动脉处理,其中仅1例患者术后出现脑过度灌注综合征。本组患者术后1周内复查CTA或DSA显示颈动脉狭窄均消失。术后随访3~18个月,仅1例患者在术后第10 d出现术侧手功能区小片状脑梗死,其他患者均无出现并发症。结论TCD与SEP联合监测在CEA术中具有较高的临床应用价值;SEP在判断术中是否使用转流方面更有优势,TCD在判断CEA术中高灌注方面有优势。     

超声多模式评估脑出血患者颅内压增高的临床价值

目的 探讨超声多模式联合检查评估脑出血患者颅内压(ICP)增高的临床价值.方法 纳入2019年9月至2021年6月延边大学附属医院重症监护病房内因病情需要行腰椎穿刺术的脑出血患者17例,在腰椎穿刺术前行超声测量视神经鞘直径(ONSD)及经颅多普勒超声(TCD)检查.根据脑脊液压力结果(大于200 mmH2 O定义为颅内...     

Critical closing pressure in cerebrovascular circulation

OBJECTIVE: Cerebral critical closing pressure (CCP) has been defined as an arterial pressure threshold below which arterial vessels collapse. Hypothetically this is equal to intracranial pressure (ICP) plus the contribution from the active tone of cerebral arterial smooth muscle. The correlation of CCP with ICP, cerebral autoregulation, and other clinical and haemodynamic modalities in patients with head injury was evaluated. METHOD: intracranial pressure, arterial blood pressure (ABP) and middle cerebral artery blood flow velocity were recorded daily in ventilated patients. Waveforms were processed to calculate CCP, the transcranial Doppler-derived cerebral autoregulation index (Mx), mean arterial pressure (ABP), intracranial pressure (ICP), and cerebral perfusion pressure (CPP). RESULTS: Critical closing pressure reflected the time related changes in ICP during plateau and B waves. Overall correlation between CCP and ICP was mild but significant (R=0.41; p<0.0002). The mean difference between ABP and CCP correlated with CPP (R=0.57, 95% confidence interval (95% CI) for prediction 25 mm Hg). The difference between CCP and ICP, described previously as proportional to arterial wall tension, correlated with the index of cerebral autoregulation Mx (p<0.0002) and CPP (p<0.0001). However, by contrast with the Mx index, CCP-ICP was not significantly correlated with outcome after head injury. CONCLUSION: Critical closing pressure, although sensitive to variations in ICP and CPP, cannot be used as an accurate estimator of these modalities with acceptable confidence intervals. The difference CCP-ICP significantly correlates with cerebral autoregulation, but it lacks the power to predict outcome after head injury.     

Association between intracranial, arterial pulse pressure amplitudes and cerebral autoregulation in head injury patients

OBJECTIVE: To explore whether intracranial pulse pressure amplitudes relate to arterial pulse pressure amplitudes and whether correlations between time-related changes in intracranial and arterial pulse pressure amplitudes associate with indices of cerebral autoregulation. METHODS: A total of 257 continuous and simultaneous intracranial pressure (ICP), arterial blood pressure (ABP) and middle cerebral artery (MCA) blood velocity recordings were obtained 1-14 days after ictus in 76 traumatic head injury patients and analysed retrospectively. Clinical outcome was assessed using the Glasgow outcome scale (GOS). Pulse pressure amplitudes of corresponding single ICP and ABP waves were correlated in consecutive 200 wave pairs. Mean ICP, mean ABP and mean ICP wave amplitudes, and mean and systolic MCA blood flow velocities, were computed in consecutive 6 second time windows. The indices of cerebral autoregulation PRx (moving correlation between mean ICP and mean ABP), and Mx and Sx (moving correlation between mean and systolic MCA blood velocity and cerebral perfusion pressure) were calculated over 4 minute periods and averaged over each recording. RESULTS: Intracranial pulse pressure amplitudes were not related to arterial pulse pressure amplitudes (mean of Pearson's correlations coefficients: 0.04). Outcome was related to mean ICP, PRx and Sx (p 相似文献